And with this decision, implemented on Friday (see NHS announcement below), the UK joins several other European countries—Finland, Norway, and Sweden—in removing adolescents’ access to puberty-blocking hormones except in clinical trials. This is clearly a significant decision given the UK’s previous reassurances, in the Tavistock Gender Centre, that puberty blockers were perfectly safe and reversible.
And this reassurance is still given all over America, too, conveyed to adolescents contemplating “stalling” puberty until they decide what to do. (Most decide to continue with the transition, going on to full male or female hormone treatment and/or opting fur surgery.)
But such assurances of safety and reversibility are not credible right now, for we just don’t have enough data to deem puberty blockers (used off label) as either “safe” or “completely reversible”. In fact, there are suggestions of some possible physical harms, harms that the NYT wrote about in both January and November of last year. We won’t know for sure until proper clinical trials are done. Until then, it’s irresponsible to prescribe these drugs outside of a trial. And of course proper warnings and written assent of patients that they understand the warnings are essential.
Here’s what else is irresponsible: writing an article about possible harms of puberty blockers but mentioning only psychological harms, neglecting the physical ones. Click below to see the NYT’s new article about this (and at least they covered it); I also found it archived here.
After in the article above, the NYT adds this about possible “harms” (they do say that the NHS “stated that ‘there is not enough evidence to support their safety or clinical effectiveness as a routinely available treatment’.”)
Background: Data on the effects of blockers is sparse
Last year, the N.H.S. announced that it would be shutting down the country’s only youth gender clinic after an external review showed that the Tavistock Gender Identity Development Service had been unable to provide appropriate care for the rapidly increasing number of adolescents seeking gender treatments. The clinic had seen a sharp rise in referrals, from 250 young people in 2011 to 5,000 in 2021.
Puberty blockers, which work by suppressing estrogen and testosterone, were first tested on children with gender dysphoria in the Netherlands in the 1990s. The Dutch researchers published their first study on 70 children in 2011, finding that the adolescents reported a decrease in depression and anxiety after taking the drugs.
But a British study of Tavistock patients published in 2021 showed that blockers had no effect on children’s scores on psychological tests. The study found that 43 out of the 44 participants later chose to start testosterone or estrogen treatments. One interpretation of the data is that all were good candidates for hormone therapy. But the numbers raised concerns at the N.H.S. about whether the drugs served their intended purpose of giving adolescents time to think.
“The most difficult question is whether puberty blockers do indeed provide valuable time for children and young people to consider their options, or whether they effectively ‘lock in’ children and young people to a treatment pathway,” Dr. Hilary Cass, the pediatrician overseeing the independent review of the N.H.S. gender service, wrote last year.
Note the absence of any mention that there’s more than psychological harm at stake, and the lack of any report that long-term physical harm hasn’t been properly studied.
But see this from the NYT article in January of last year:
Few studies have followed adolescents receiving puberty blockers or hormones into adulthood. Dr. Ehrensaft and others are now working on large, long-term studies of patients in the United States.
. . . Puberty blockers, for example, can impede bone development, though evidence so far suggests it resumes once puberty is initiated. And if taken in the early phase of puberty, blockers and hormones lead to fertility loss. Patients and their families should be counseled about these risks, the standards say, and if preserving fertility is a priority, drugs should be delayed until a more advanced stage of puberty.
. . .Experts in transgender health are divided on these adolescent recommendations, reflecting a fraught debate over how to weigh conflicting risks for young people, who typically can’t give full legal consent until they are 18 and who may be in emotional distress or more vulnerable to peer influence than adults are.
Here the article appear sto be talking about post-blocker treatment with male or female sex hormones.
Some of the drug regimens bring long-term risks, such as irreversible fertility loss. And in some cases, thought to be quite rare, transgender people later “detransition” to the gender they were assigned at birth. Given these risks, as well as the increasing number of adolescents seeking these treatments, some clinicians say that teens need more psychological assessment than adults do.
And here’s what the NYT said last November:
Dutch doctors first offered puberty blockers to transgender adolescents three decades ago, typically following up with hormone treatment to help patients transition. Since then, the practice has spread to other countries, with varying protocols, little documentation of outcomes and no government approval of the drugs for that use, including by the U.S. Food and Drug Administration.
But there is emerging evidence of potential harm from using blockers, according to reviews of scientific papers and interviews with more than 50 doctors and academic experts around the world.
The drugs suppress estrogen and testosterone, hormones that help develop the reproductive system but also affect the bones, the brain and other parts of the body.
During puberty, bone mass typically surges, determining a lifetime of bone health. When adolescents are using blockers, bone density growth flatlines, on average, according to an analysis commissioned by The Times of observational studies examining the effects.
. . .Many doctors treating trans patients believe they will recover that loss when they go off blockers. But two studies from the analysis that tracked trans patients’ bone strength while using blockers and through the first years of sex hormone treatment found that many do not fully rebound and lag behind their peers.
That could lead to heightened risk of debilitating fractures earlier than would be expected from normal aging — in their 50s instead of 60s — and more immediate harm for patients who start treatment with already weak bones, experts say.
“There’s going to be a price,” said Dr. Sundeep Khosla, who leads a bone research lab at the Mayo Clinic. “And the price is probably going to be some deficit in skeletal mass.”
So why didn’t the NYT emphasize, in its latest article, that some doctors think there are long-term physical harms that may come from blockers? That was, after all, one of the reasons why the NHS and other nations in Europe have limited their use to clinical studies. I can guess only that they don’t want to get into the messy (but necessary) details.
The NHS announced the policy taking effect in a curiously anodyne statement on “Implementing advice from the Cass Review“, referring to a scathing indictment of the Tavistock clinic by Hilary Cass, former President of the Royal College of Paediatrics and Child Health). Here’s the bit about blockers, with a link to more on another site:
We are now going out to targeted stakeholder testing on an interim clinical commissioning policy proposing that, outside of a research setting, puberty suppressing hormones should not be routinely commissioned for children and adolescents who have gender incongruence/dysphoria.
The purpose of the clinical policy is to formalise this commissioning approach and ensure there is clarity on the position by the time the new service providers begin seeing patients in the context of the new and final interim service specification. The interim service specification and the clinical policy, once finalised, come together to define the overall commissioned service.
NHS England has established a new national Children and Young People’s Gender Dysphoria Research Oversight Board which has now approved the development of a study into the impact of puberty suppressing hormones (‘puberty blockers’) on gender dysphoria in children and young people with early-onset gender dysphoria. More information on the Board and the study can be found in the consultation report.
The U.S. really should take these other countries’ decisions more seriously. Indeed, puberty blockers have been banned in ten U.S. states, along with a general ban on “gender-affirming care.” Those states are all Republican, and so the Democrats and gender activists have become enraged, deeming these laws “transphobic”. And indeed, perhaps an animus against trans people has motivated some of the laws’ stipulations, but I’m talking only about the bans on puberty blockers. Until we know more about them, it seems wise to do the clinical studies. Yes, it’s possible and even likely that the blockers won’t erode mental health, and may even improve it in gender-dysphoric children, but mental health is not the only issue at stake.
Further, since about 70% of children diagnosed with gender dysphoria eventually grow out of it without hormone treatment, often becoming lesbian or gay, it also seems that we should hold off on these blockers and replace them with empathic (not “affirmative”) therapy. Given the high incidence of resolution without blockers, the possible medical damage, the lack of long-term studies, the fact that most children on blockers go on to full transition, taking sex hormones and sometimes getting surgery (a course that renders them infertile and often unable to achieve orgasms), and the unlikelihood of children as young as 10 or 11, when puberty begins, being able to make informed and irreversible medical decisions—all this makes me think that the U.S. should follow the lead of Europe: use blockers only in clinical trials until they’re proven to be safe (or unsafe).
That is not, of course, to say that children with gender dysphoria shouldn’t be treated. What they need until the age of consent for transition (I tend to favor 18, but your mileage may very) is good psychological therapy, not therapy in which the doctor eggs on children to take blockers and then become transsexual. Good therapy is not just one or a few sessions with an explicit goal of transitioning, but listening to children and helping them work out their issues. If, at the age of consent, they still want to transition, by all means allow them to do so and support them.
The NYT seems to have a curious attitude toward puberty blockers. First it takes two steps forward, calling out their dangers, and then takes one step back, hiding their dangers.
__________
UPDATE: For a stronger negative view of puberty blockers, see this WSJ op-ed.
I’m not convinced they need anything at all. It may be better to treat signs of gender dysphoria as just a teenage fad, akin to them adopting a weird hairstyle or such.
There’s no good evidence that just leaving them be (while continuing to regard them as the sex they are) leads to worse outcomes than “affirming” their declared “identity”. The evidence seems to be that 80% or so will grow out of it.
Largely agree with Coel, there may be a minute segment of pre-pubescent kids who do need Puberty Blockers and “Transitioning”, but it is likely a vanishing minority. The vast majority will grow out of it.
Well, if it’s severe then it’s a psychological problem, and if it’s interfering with their lives, like any such problem, therapy is a way to deal with it.
I think you are confusing two different populations. Gender dysphoria is either early-onset (i.e. prior to puberty) or late-onset (see the DSM 5 pages 455-456). The 21st century phenomenon of ROGD or teenagers getting caught up in the trans trend is a novel late-onset type and should be treated like any other teen trend, I agree.
However, for children with early-onset gender dysphoria, it’s different. These are children whose natural, pre-homosexual gender nonconforming behavior stands out, which may alarm their parents, particularly traditional ones. Their behavior may also lead to bullying by their peers. They will be under significant pressure to conform to gender roles. Navigating all that can be hard for a child, so there would be value for therapy in this case. I think that’s the sort of therapy being recommended in the snippet you quoted. It’s the early-onset children who are likely to grow out of it, and they could use help in getting through it.
Yes, life can be tough for such kids, and yes they should be supported, and no they shouldn’t be forced into narrow gender roles. And most of these kids will grow up to be gay rather than “trans”.
But I’m not convinced that “therapy”, as opposed to supportive and understanding adults in their lives, is of much use.
Coel, if you don’t know this documentary, you might find it interesting (it describes some cases of early onset gender dysphoria, interviewing the parents, and some therapists who treated these children):
Transgender Kids: Who knows best? BBC2 This World, 2017, 59 mins
I saw this a couple of years ago. It was a balanced and fair doc, but as always, the reaction from trans activist was as expected, not positive
https://www.theguardian.com/society/2017/jan/11/bbc-film-on-child-transgender-issues-worries-activists
https://www.transgendertrend.com/transgender-kids-who-knows-best/
I am Norwegian and here major newspaper and television (The so called Main Stream Media) has no problems reporting and writing about this issue seen from both sides.
As a Norwegian I am shocked to see how divise this debate has become in USA and Canada.
Also, when MSM Norwegian media write about this stuff the vast majority of comments seems to be of the gender critical types. Of course, we have some rather radical trans activist here too, but nowhere close to the madness one can see in the USA and Canada.
I definitely feel that the tide is turning now, more and more people here dare to speak out against the most radical trans activist and these critical voices do it under full name in the newspaper comment section. I am myself one of these gender critical people (and a biologist) and I am definitely not a right wing conservative. Most Americans would probably call med a socialist
Bjorn, I’m asking you as a Norwegian, is there any news on this?:
Meghan Murphy: Christina Ellingsen is facing prison time for saying that men can’t be women
https://www.feministcurrent.com/2022/07/22/christina-ellingsen-is-facing-prison-time-for-saying-that-men-cant-be-women/
Norwegian feminist Christina Ellingsen is facing a prison sentence of up to three years for saying that men cannot be lesbians or mothers. Country contact for Women’s Declaration International (WDI) in Norway, Christina is being investigated under hate crime charges for tweets she made between February 2021 and January 2022, directed at Christine Marie Jentoft, a representative for Norwegian trans activist group, Foreningen (FRI), such as, “You are a man. You cannot be a mother.”
The case was dismissed
https://verdinytt-no.translate.goog/saken-er-henlagt/19.184?_x_tr_sl=no&_x_tr_tl=en&_x_tr_hl=no&_x_tr_pto=wapp
That said, this case has been misrepresented in the foreign press
Christina has been saying worse thing than just “You are a man. You cannot be a mother.”
See here what this site says (and Subjekt is definitely not pro trans activist, but a magazine which often publish gender critical articles)
https://subjekt-no.translate.goog/2022/07/17/smaklose-og-svaert-usaklige-ytringer-fra-christina-ellingsen/?_x_tr_sl=no&_x_tr_tl=en&_x_tr_hl=no&_x_tr_pto=wapp
The law against hate speech in Norway is strict, I think myself the law as it is now should be changed or better removed because is threaten freedom of speech. We really do have freedom of speech in Norway. People, under full name, say stuff like:
Transwomen are men with a sexual fetish
Trans women can’t be lesbian, they are men acting as women
Trans genderism is a mental illness
……and so on
..in the main stream media without being reported to the police.
For some reason (unknown to me) English-speaking countries (the USA, the UK, Canada, New Zealand, etc.) are crazier (on the gender issue) than non-English-speaking countries. Of late, we have the disturbing tale of a woman (Maria) being hounded out of Oxfam for daring not to oppose J.K. Rowling. See “‘I was hounded out of Oxfam over JK Rowling’” (https://unherd.com/2023/06/i-quit-oxfam-over-jk-rowling/). A good example is the following quote from the article
‘Earlier this year, Oxfam updated its language guide, which is an internal document advising staff how to speak about its work. The document includes the instruction that, rather than using the phrases “biological male” and “biological female”, “AMAB and AFAB” (assigned male/female at birth), should be used instead; and when talking about “expectant mothers”, use the phrase “people who become pregnant”.’
Of course, AMAB and AFAB are not accurate (sex at birth is observed, assigned). By contrast, language that refers to “biological male” and “biological female” are accurate (if verboten at Oxfam). However, the word ‘mother’ has no gender connotations (as they would see it), but is still verboten.
You are referring to “sissy” boys and “tomboy” girls who go on to be gays and lesbians. Yes, I know plenty of people like that, including me. But it’s important to note that plenty of gay/lesbian are totally gender conforming.
Apparently at Tavistock some of its clinicians adopted an attitude of “trans away the gay”. In fact, some joked about how if they kept going the way they were going there would be no more gays/lesbian left.
Quercus, Remember though, that the long-term follow-up by Kenneth Zucker at CAMH that showed nearly all grew to align with their sex and 80-90% turned out to be gay, was done long before the 5,000% increase in referrals to the Tavistock that resulted from trans trendiness. So even our good old fashioned “true” gender dysphorics don’t have only transition as an option. That’s why watchful waiting was recommended.
Adolescents who identify as transgender often do so as a coping mechanism for serious problems, mental and environmental. Unresolved trauma, abuse, bullying, brain/personality disorders, depression, anxiety or problems fitting in due to autism or other reasons are “explained” and “solved” by an easy diagnosis which comes with a positive story arc, a supportive community, and new, more socially acceptable reasons for still feeling bad (transphobia.)
That’s why techniques such as Gender Exploratory Therapy or Cognitive Behavioral Therapy can be very useful. Rejecting one’s sex is often not just a popular “phase.” Increasing self-awareness, exploring inner motivations, and gaining some insight into how to heal and deal with the background issue or issues is usually going to be better than no treatment at all.
Appreciated.
I’ve always thought it strange that children are considered too young to drink alcohol or smoke which could damage their bodies, but puberty blockers are thought to be risk free (by some) and therefore down to a child’s choice. Or could it be a case of the ‘ends justifying the means’?
My guess is that there will be a slow transition toward sanity in the U.S.—one that will allow trans-activists to save face. First the risk of psychological harm will be recognized; eventually you’ll see the word “physical” slip in discretely. I don’t think that puberty blockers will be banned in the U.S. before age 18 (or some other age), but I do believe that standard medical practice will come around to avoid prescribing them in children and youth before the age of majority.
Perhaps. However, multiple states have already banned puberty blockers. https://www.medpagetoday.com/special-reports/exclusives/104425
Yes. By “banned in the U.S.” I meant at the federal level. We’ll see how far the banning at the state level goes.
I support the bans, despite having legitimate misgivings on the intent of the bans; however, when it comes to a child’s life, it’s the practical aspect that matters, not the intent of the bans. No child can offer informed consent. Chloe Cole’s case should present a grave/tragic warning. https://www.dailymail.co.uk/news/article-11619823/Detransitioner-Chloe-Cole-slams-breast-removal-op-endured-aged-15-child-protection-appeal.html
Puberty Blockers (generally) lead to a life time of medicalization and transitioning (mastectomies/orchiectomies). The bans will likely be challenged in court, and I hope SCOTUS upholds the bans in the context of *informed consent* and the absence of longitudinal studies, though there is no guarantee. My hope is that the Norwegian natinos and the UK will move to install good studies now that there are nation-wide bans in those nations (with narrow exceptions).
And yes, of course, there need to be carefully considered exceptions.
Sorry, I mean England, not UK. the NHS ban only applies to England, not Scotland nor Ireland.
RE you writing “The bans will likely be challenged in court”:
Judge Sides With Families Fighting Florida’s Ban on Gender Care for Minors. New York Times, June 6, 2023
A federal judge wrote that the plaintiffs suing to block the new law are “likely to prevail on their claim that the prohibition is unconstitutional.”
https://archive.is/H0YAz
I agree that the Supreme Court (SCOTUS, for the benefit of foreign readers here) will eventually rule on this.
Thanks Peter. If bans on alcohol consumption and gun ownership stand (at the federal level), then, my hope is that bans on puberty blockers will, as well. OR, I hope SCOTUS sends it back to the states.
The FDA needs to be roped into the conversation, as well as congress. Norway, Sweden, Denmark, the UK, all have restrictions on administering puberty blockers. The US, Canada, NZ, and OZ will likely be the last of the western world to follow. This issue (gender ideology/puberty blockers) will feature dominantly over the next year (election year). The tide is definitely turning, but often in ways that are not optimal. The pendulum will -no doubt- swing too far in the “other” direction.
The author of the WSJ piece (referred to at the end of Jerry’s post) promises a lengthier expose on the safety, efficacy of puberty blockers.
It is hard to see how Canada will ever unwind its public commitment to trans-women-are-women or reverse course on child transitioning. It is now a federal crime (punishable by up to 2 years in prison) for a professional psychologist or therapist (or anyone else) to counsel someone with gender dysphoria to accept their sexual reality and help such a person adjust their thinking about themselves to match their sex. This therapeutic approach to treating gender dysphoria has been lumped in with religious bullying of gays and lesbians, labelled “conversion therapy”, and criminalized. The law simply assumes that gender identities are immutable inborn properties of individuals that require respect and affirmation. As part of the same forced teaming that goes on elsewhere, news articles about the law focus on religious indoctrination and abuse of LGB people, but feature hulking TQ dudes like “Gemma Hickey”.
https://www.ctvnews.ca/politics/a-year-after-canada-banned-conversion-therapy-ottawa-says-no-criminal-charges-laid-1.6218373
Sad. I hear you, It will take massive grass roots advocacy to turn the tide. Did you hear about the protests in Canada (Ottawa), featuring Billboard Chris? It’s not clear to me how to react to these protests. On the one hand, I’m glad they are happening, on the other hand, they are highly charged events that can often lean to a form of “hate”.
https://twitter.com/BillboardChris/status/1667281297041915904
“Billboard Chris,” he’s quite the guy:
Andrew Doyle interviews Canadian activist Billboard Chris
“There are two sexes, zero genders and infinite personalities…we need to abolish this entire ideology that teaches that stereotypes define who our kids are.”
GB News, May 21, 2023, 11 mins
https://www.youtube.com/watch?v=4TecvLdbdTU
Well, I don’t agree with “there are zero genders,” but otherwise this guy is very level-headed.
He’s correct about gender in that gender is a grammatical term that operates in languages that use it, not to people. People don’t have gender, only nouns, adjectives, pronouns, and sometimes participles do, and then only in some languages. Because gender is vestigial in English—the term only comes up when we start to learn French in Grade 4-–it is an idle word just standing around waiting to be press-ganged into the service of some disruptive ideology. In this case as a euphemism initially for “sex” (the attribute, not the act), and then for “sex role stereotype.”
Concur. The word gender needs to vanish, or it needs to be made synonymous with the word sex. Yes, I like BillBoard Chris, he has enormous+ courage. What I meant was (and I don’t know if you saw it), the Ottawa protest led to some kids stomping on the pride flag… that’s a bridge too far. It’s (well) “dangerous” and makes for bad optics as well. If we are to win this battle and the war, we need to stay rational. Still, I empathize with the muslim immigrants who are furious at this ideology forcing its way into their kids’ schools. I am a first generation immigrant (as well), I don’t appreciate leaving a repressive regime, arriving at the shore of the “free world” and being lectured prescriptively on how men can become women in order to occupy my “safe” spaces. It sucks. It’s unfair and in the context children (transitioning), it’s horrific.
Have you seen this? It’s great: love this woman…
https://twitter.com/CoachCaroline/status/1667520224994754561
Peter, thought I responded to this, but the response seems to have vanished. 🙂
Yes, Billboard Chris has super powers and is enormously courageous+. I just worry about the passion stirred up by his advocacy.
https://twitter.com/BillboardChris/status/1667746296793366528
Re: gender, the word gender should vanish or be made synonymous with sex.
Gender and sex are certainly intertwined. So I would say that there are at least 2 genders.
In this regard, this could be interesting:
Alex Byrne: Letter to the editor: The Origin of “Gender Identity.” Archives of Sexual Behavior (2023)
ungated: https://philpapers.org/archive/BYRTOO-7.pdf
https://link.springer.com/article/10.1007/s10508-023-02628-0
Byrne is a philosopher from MIT, married to biological anthropologist Carole Hooven (Harvard) who herself is the author of the very interesting T: The story of testosterone, the hormone that dominates and divides us. 2021).
Byrne is also the author of Trouble With Gender: Sex Facts, Gender Fictions to be published by Polity Press in the UK on Oct 12, 2023
https://www.amazon.co.uk/Trouble-Gender-Sex-Facts-Fictions/dp/1509560017
I thought the article missed an important point in the very first paragraph.
“The change [puberty blockers only as part of clinical trials] comes as the agency’s pediatric gender services have struggled to keep up with soaring demand.” But the article doesn’t say that a big part of the surge in demand is caused by advocacy by the charity Mermaids, whose leaders were not physicians but were in direct communication with Tavistock doctors and who directly referred children for treatment.
https://www.dailymail.co.uk/news/article-12134475/Boss-trans-charity-Mermaids-referred-children-NHS-Tavistock-gender-clinic.html
OTOH the NYT reporter writes a lot on this subject and in general is a fair reporter. This story,
https://www.nytimes.com/2022/09/26/health/top-surgery-transgender-teenagers.html
about the tiktok butcher in Miami, includes balanced reporting on and interviews with detransitioners. The story is slanted toward the support-trans-kids view but doesn’t ignore other views.
I was about to enter a comment about your point. But I disagree that the NYTimes misses it……It’s done on purpose. Except for a few articles during a period of a year that now seems over, the NYTimes reporting on this issue has consisted in large part of activist talking points. (Listen to the Ezra Klein interview from late April with an activist and note how none of the issues in Europe, controversy, etc are ever touched on.)
In England, when Tavistock was ordered closed, there was almost an immediate effort by activists to spin the closure as stemming from issues related to increased patient load….concurrently, there was pushback saying that no, the reasons were largely clinical. So now the NYTimes is just picking the activist spin.
Here is a twitter thread from Hannah Barnes, author of “Time to Think”, which I am reading now and highly recommend on the announcement…..not long and better than the NYTimes article.
https://twitter.com/hannahsbee/status/1667160047149887488
Thanks for this, and yes, Hannah Barnes is on point.
I agree with dd and disagree with Mike: The New York Times’ coverage on transgender youth medicine and trans issues in general is sub par. And this is not because the Times does not have excellent journalists. It’s because of editorial decisions made at the top of the Times hierarchy.
This is from a journalist who left the Times in July 2016, after almost 12 years as an editor and correspondent:
Michael Cieply: Stunned By Trump, The New York Times Finds Time For Some Soul-Searching. Nov 10, 2016
https://deadline.com/2016/11/shocked-by-trump-new-york-times-finds-time-for-soul-searching-1201852490/
Here are four indicators to judge the quality of journalism when the topic is transgender stuff:
1) Does the article claim that puberty blockers are reversible? – We don’t know that. The evidence we have rejects this claim.
2) Does the article tell you that many medical associations in the US support gender affirming care? – True, but misleading. There is not one medical association in the US that has based its statements in support of gender-affirming care on a rigorous systematic review of the evidence. Not one! Not the American Academy of Pediatrics. Not the Endocrine Society – it’s guidelines are about the how of gender transition not about whether puberty blockers and cross-sex hormones are a good idea in the first place.
See here:
Lisa Selin Davis: Major Medical Associations Support Gender Affirming Care. So What? April 19, 2023
Clinician advocacy groups are not neutral
https://lisaselindavis.substack.com/p/major-medical-associations-support
3) Does the article claim that the rate of detransition is low or that experts believe it to be low? – This rate is unknown. There are no good-quality studies on this issue. Even the statement that experts believe that rate to be low is misleading. What is low? Who cares about what experts believe if these believes are not supported by scientific evidence?
See here:
Scott Gavura: Fooling myself. June 2, 2016
https://sciencebasedmedicine.org/fooling-myself/
And here: David Isaacs & Dominic Fitzgerald: Seven alternatives to evidence based medicine. British Medical Journal (BMJ), 18-25 December 1999, Vol 319, page 1618
https://www.bmj.com/content/bmj/319/7225/1618.full.pdf
4) Does the article use the expressions “culture war” or “moral panic” to avoid telling the readers what opponents of the radical trans agenda think?
There are some journalists whose writing on trans issues are trustworthy: Lisa Selin Davis, Jesse Singal, Bernard Lane, Leor Sapir (not a journalist, Harvard Ph.D. in political philosophy or political science, writes for City Journal, published by the right-leaning Manhattan Institute, New York). The first three are mainly writing on Substack. Coincidence? Certainly not!
I’ve been reading the New York Times for 25 years. In the last three years the Times has published about 6 good-quality articles on trans issues. The overwhelming majority of Times articles on trans issues are distorted and misleading because the issues are viewed through a partisan/woke lens. Transgender people, because of a history of discrimination, are viewed as sacred victims. Hence, what radical transgender activists say goes. They can’t be wrong. If you criticize their views, then you are ipso facto transphobic. You are charged of arguing from a position of hate, fear or ignorance. (Analogous to Jerry allegedly “punching down,” when he criticizes the howlers that were published recently in Scientific American.)
Great comment.
The mantra of “every major medical association in the US approves of gender affirming care” is repeated again and again in newspapers and by people i know.
It’s a consensus based consensus, not evidence base. In essence, an epistemic ponzi scheme.
100% agree with you, Peter. On all points. Also a 25 year NYTimes reader.
D.A.
NYC
For sure the NYT reporting on gender has in general been atrociously biased. My comment was specifically about this reporter Azeen Ghorayshi who has done balanced and fair reporting on the subject.
Once upon a time, methods of execution were compared in terms of their avoidance of being “cruel and unusual”. Thus, the guillotine was touted as less painful than hanging, and the electric chair was promoted as more comfortable than either. These discussions were never enlivened (if that is the right word) by attaching the word “affirmative” to one method or another. Of course, in those days postmodernism, with its idolatry of words, had not yet been invented. But there actually were states, like Tennessee, in which the condemned individuals were permitted to choose between lethal injection and old sparky for their own demise—a choice which could well be called “affirmative execution”.
In the USA, the Netherlands and the Scandinavian countries, politicians are slowly coming to their senses.
In Germany, the battles are yet to come. Individual members of the governing parties, the Green Party and the SPD, are demanding that children should decide for themselves about their gender from the age of 7(!). These people also insist that these childs can then, if necessary, be given puberty blockers, even against the will of their parents. The well-being of the so-called trans children would have to be the center of attention.
The disturbing point about this discussion is also that the Queer Representative of the Federal Government, a Parliamentary State Secretary, does not agree with this demand, but has not explicitly rejected it either.
https://twitter.com/shadygrooove/status/1667291080445022208
It’s hard to imagine that a randomized controlled clinical trial of puberty blockers for gender dysphoria will ever be done. The manufacturer would have no interest in funding such a trial, suspecting that the trial would only confirm the already emerging consensus of nebulous or negligible psychological benefit (except in the minds of the zealots) and some risk of serious harm delayed by decades, which would require decades of expensive follow-up to detect or exclude. The only up side for the manufacturer would be to be able to apply for regulatory approval to market the drugs for this new purpose if the trial showed clear benefits. That would be an investment decision that is usually judged to be “in the money” only for new drugs with strong pre-trial optimism but which can’t be marketed at all until the regulator approves. Pharma does sometimes seek approval to add an indication to the labeling of an existing drug but there has to be a big enough market in mind. (The new anticoagulants are a recent example.)
The drug company would expect to be able to raise its prices considerably, to recover the cost of the trial and for the value of the evidence that the drugs were indeed effective, just as it does when it prices a new drug. But if the drug was already available off patent from generic copiers, the sponsoring company would simply lose market share to the generic competitor, who would still undercut the innovator even if both raised their prices. Generic manufacturers do not fund research in their business plans
So a clinical trial would have to be sponsored by some public agency, with research dollars that are already the subject of sharp-elbowed competition with other important research questions. Public agencies don’t generally like drug trials as they aren’t scientifically interesting and they are considered industry’s job. Trials that got funded would likely be small, like the numerous ivermectin trials in Covid-19 that were individually too small to exclude confidently a small but potentially relevant benefit, even if you exclude the fraudulent ones. And with Covid, the outcomes are cut and dried: dead or alive after short treatment courses and short follow-up.
“No puberty blockers except in clinical trials” is a conflict-reducing way of saying “no puberty blockers.” In the current state of knowledge this is a welcome recommendation.
I understand that puberty blockers are for “pausing” puberty – don’t think that any trial would have to establish a significant psychological benefit, rather that they “pause” puberty without causing short or long term ill effects. I believe that current majority (greater than 60% ??) consensus shows net negative effects – bone density loss etc
Good points which deserve comment. A trial can look at any effect the researchers think is scientifically or medically valuable. In planning a trial, and in writing their grant application, the investigators discuss a number of focussed, testable hypotheses they’d like to study. Generally speaking. trials are done to see if a treatment is beneficial, not merely to reassure us that it is not harmful. If you can’t prove a drug is beneficial there is no point in risking any harm at all. It is also much harder statistically to “prove” that no harm results. (Absence of evidence is not the same as evidence of absence, that kind of thing.). So trials are planned with a sufficient number of participants to have a good chance of detecting a gratifyingly large treatment benefit (if one exists), rather than to exclude risks of serious harm. Besides, as you point out, we already know there are harms, which the enthusiasts tend to blow off.
Since we already know thar puberty blockers prevent the brain from driving precocious puberty, it’s not likely that a trial testing only whether they block normal puberty too would get funded. You’d want to look at whether doing this benefitted the subjects receiving the puberty blockers at some specified dose for some specified time, as compared to control subjects receiving only psychological counseling plus placebo. Since the only benefit claimed for puberty blockers is reducing psychological distress, this would have to be the primary outcome measure of the study.
You also find that once a treatment becomes widely used and popular it attracts a cadre of true believers. They will insist loudly that it is “unethical“ to do a clinical trial where half the participants will be randomized to placebo and thus not get these “life-saving” drugs that prevent suicide. Research ethics boards afraid of being accused of transphobic genocide may refuse to allow the trial to be done. Even if the trial goes ahead, some subjects will cheat and take the drugs anyway from other sources if they suspect they are getting placebo, thus fatally undermining the trial, ironically hiding any benefit that might have been detected otherwise!
The more I think about this the less likely I think a clinical trial of puberty blockers will ever be done. The treatment will just die a quiet death wherever the “clinical trial” rule is enforced and will be used with great uncontrolled enthusiasm elsewhere.
Actually, they may be iatrogenic.
I think part of the reason Hannah Barnes calls her book “Time to Think” is because that’s what parents and children are told, but as I said they may be an accelerant to go to sex-change hormones and maybe surgery. So the book’s name may be in part ironic.
To me, the current “gender-affirming care” of children and psychologically troubled adults is just one example of un industry changing the bodies of vulnerable people because of financial and other interest, a phenomenon which I find abhorent. Other examples are: cosmetic surgery preying on women with low self-esteem, genital mutilation of girls in some Third World Muslim societies, and circumcision of boys. I find it curious that some people repulsed by the genital mutilation of girls in Third World countries consider the genital surgery of alleged transgender children in the West the epitome of progress. To me, if I have to choose one as the lesser evil, I’d vote for the Third World genital mutilation, because it at least does not intend to, and usually does not make the victim sterile.
Various pre-modern cultures had an assortment of body modification practices: beside the better known female genital mutilation, there was foot-binding, piercings, scarification, and in quite a few cultures tattooing. I wonder if it is just a coincidence that the recent craze for the “affirmative care” type of body modification coincides with a more general fad for tattooing in the US and perhaps the Anglosphere.
Agreement on this. Good article, including recognition that people who, when able to, make a choice to transition, can do so with support and without prejudice. Important to distinguish this issue from legislation banning trans people in entirety, which is abominable. This is solely about forced, unnecessary bodily interference, which is also a contravention of basic human rights. Parents wishing to spare their children pain and harm from social prejudice is an understandable reason for intervention but not sufficient to over-ride basic rights, especially where physical danger may exist. It would be better that we all accept difference and place no moral value judgment on it.