This WaPo article below (click headline to read, or find the piece archived here), discusses the new case about gender transitioning being adjudicated by the Supreme Court. It’s judging the constitutionality of a Tennessee law that, according to the paper, “bans the use of puberty blockers and hormones for gender-transition treatments in minors on the grounds that it unlawfully discriminates based on sex.” (23 other states have similar laws). I’m not sure how a ban on blockers can discriminate on the basis of sex if the hormones are banned in both males and females, but I’ll leave that up to the lawyers.
What’s important here is that the dispute about the blockers is now being discussed openly, in an Editorial Board op-ed in the Washington Post, while previously such discussion was taboo. Even questioning the use of such “affirmative treatments” was seen as “transphobic,” though there wasn’t good clinical evidence that they had good outcomes. They could even have been harmful, and in light of a lack of efficacy, they’re now banned in the UK and regarded as experimental treatments in much of Europe.
What we need, as the paper says, are “gold standard” studies: large controlled studies (double blind ones would be impractical given that the drugs have easily discernible effects) over a fairly long period of time.
Read below, and I’ll give some quotes (indented):
This unresolved dispute is why Tennessee has a colorable claim before the court; it would be ludicrous to suggest that patients have a civil right to be harmed by ineffective medical interventions — and, likewise, unconscionable for Tennessee to deny a treatment that improves patient lives, even if the state did so with majestic impartiality. The issue is subject to legal dispute in part because the medical questions have not been properly resolved.
Multiple European health authorities have reviewed the available evidence and concluded that it was “very low certainty,” “lacking” and “limited by methodological weaknesses.” Last week, Britain banned the use of puberty blockers indefinitely due to safety concerns.
“Children’s healthcare must always be evidence-led,” British Health and Social Care Secretary Wes Streeting said in a press release. “The independent expert Commission on Human Medicines found that the current prescribing and care pathway for gender dysphoria and incongruence presents an unacceptable safety risk for children and young people.”
An early Dutch study of blockers showed “promising results”, but the sample was too small to give definitive results, and wasn’t replicable:
Yet as other doctors began copying the Dutch, clinical practice outraced the research, especially as treatment protocols rapidly evolved. A British study attempting to replicate the Dutch researchers’ success with puberty blockers “identified no changes in psychological function” among those treated.
Some clinicians appear reluctant to publish findings that don’t show strong benefits. The British lackluster results were published nine years after the study began, after Britain’s High Court ruled that children younger than 16 were unlikely to be able to form informed consent to such treatments.
And here is the unconscionable censorship on the part of both the American government and the WPATH organization that I haven’t yet written about:
Internal communications from the World Professional Association for Transgender Health [WPATH] suggest that the group tried to interfere with a review commissioned from a team of researchers at Johns Hopkins University
Johanna Olson-Kennedy, medical director of the Center for Transyouth Health and Development at Children’s Hospital of Los Angeles, told the New York Times that a government-funded study of puberty blockers she helped conduct, which started in 2015, had not found mental health improvements, and those results hadn’t been published because more time was needed to ensure the research wouldn’t be “weaponized.” Medical progress is impossible unless null or negative results are published as promptly as positive ones.
Weaponized? WEAPONIZED? The study is done, but the results aren’t ideologically pleasing to gender activists, and so the study languishes, unpublished. That is unethical, for whether or not one uses blockers can have permanent effects on the well being and future fertility of adolescents.
And so we have one more example of science being suppressed because it didn’t give the results activists wanted. But this story isn’t over. As the Post recommends, Congress should fund larger and wlll-conducted trials of blockers with followups on adults who have gone on to estrogen or testosterone therapy. Given the increasing number of people who want to transition, such studies are imperative. But now we lack evidence, and without that the use of blockers should, I think, be stopped. Anecdotal evidence is not enough.
Doing a study like that seems like it would be abusive in itself. Shouldn’t we be asking the question, even if puberty blockers were completely reversible and free of negative effects, should we be using them?
I’m not sure that we should do these trials, at least not yet, given that we’re talking about blocking the puberty of kids, with permanent, life-long and major, life-changing consequences.
What we should first do is audit what we currently have. That means thorough and independent follow-up studies of every individual who has already received this “gender affirming care”, many of whom are now in their twenties.
It may be that we already have enough information to know whether these treatments tend to benefit or harm gender-dsyphoric youths, if only we properly evaluated and collated it.
The gender clinics that provided the treatments are not doing these studies (perhaps because they know that they wouldn’t like the answer); they need to be forced to hand over all their records to independent research teams.
The unpublished study may already be sufficient, but we just don’t know.
Wesley Yang of Genspec gives a good half hour (or 15 min. at 2x – he talks slowly) of the state of gender.
Excellent:
https://x.com/wesyang/status/1868510054229344451
This whole issue is more insane and damaging than lobotomy.
D.A.
NYC
I never thought I would see a medical scandal of this magnitude in the 2020’s. A lack of efficacy (i.e. no better than snake oil or placebo) is one thing. Such a treatment may cost people while providing no benefit and there are many such examples. That is bad enough but to actually cause harm is unconscionable and I’m pretty sure that these drugs, which haven’t been approved for what amounts to medical experimentation on physiologically normal young adults(!), risk doing just that.
I wonder if this contributing to the mistrust in science that was so widespread in the comments of the Free Press article on vaccines.
You may trust science while accepting that scientists are often wrong. But it is more difficult to trust science when you see scientists agreeing with every crazy thing the powers that be are saying.
Agree.
You don’t do “further research”, which in this context is randomized trials, on treatments which by careful analysis of less robust forms of research already appear unlikely to have any beneficial effects. If observational studies seem to show benefit, but the design was open to biased and the results therefore not likely to be valid, that’s when you do a randomized trial, an experiment, to see if the happy result observed stands up when the sources of bias are removed by the experimental design.
In designing a proper experiment, you need some estimate of the likely effect size you are trying to detect or rule out, because this goes directly to the number of subjects you need to recruit, in each arm. This “best estimate” of effect size comes from an informed analysis of the best observational data. But if the best estimate of the effect size is zero, because that’s what the observational data already show, the trial must be infinitely large merely to confirm what you already suspect, that the treatment doesn’t work.
There are ethical challenges in all randomized experiments in human because some subjects can suffer harm from being in the experiment. If the researcher thinks it is unlikely that the treatment works, that is, he is not in a state of equipoise, he can’t recruit subjects to the trial just to satisfy himself that it really doesn’t work, or is only harmful. Only treatments that appear that they might work should be studied in human experiments.
Dr. (now Baroness) Cass recommended against the use of puberty blockers in gender care except in research settings. This routine disclaimer has been interpreted as a recommendation to actually do this research and the government is now stumbling around trying to figure out how to do a trial that doesn’t violate equipoise. (It is also impossible to blind the subjects and outcome evaluators as to whether they got PB or control, further dooming any imaginable trial.)
Doctors should simply stop prescribing puberty blockers, cross-sex hormones, and gender surgery, based on the evidence we have now. If they won’t stop, then the state has to tell them to, as Tennessee wants to.
The (London) Times journalist Janice Turner, who has consistently opposed trans activism for a long time, especially this form of child abuse, had a good article in last Friday’s issue. In relation to the call for clinical trials, she pointed out:
“Many ethical questions remain. How can you create a control group when those children on placebos would quickly know, since their puberty would begin? How can you disentangle the benefits of psychotherapy — which Cass has promised all patients — from those of a drug? How do you factor in that most patients have co-morbidities such as anorexia, autism or trauma from homophobic bullying or sexual abuse?….Above all, how do you select child patients to test a drug when 85 per cent of dysphoria cases resolve themselves at puberty — but doctors can never predict which ones? And what if participants, whose bodies and lives are changed forever, have later regrets?”
She concludes:
“It is time to throw puberty blockers into the pile of medical crazes, like lunchtime lobotomies and trepanning. End too the mad notion that demanding these terrible drugs is the metric of how much you care about gender-questioning young people. Are we really going to turn more children into lab rats because we haven’t yet convinced ideologues such as Creasy [Stella Creasy, Labour MP]? Because the chances are no medical trial, no amount of scientific evidence, ever will.”
Amen to that.
Johanna Olson-Kennedy is being sued by one of her former patients for medical negligence. Jesse Singal has an article about the case (the complaint can be read here): https://drive.google.com/file/d/1gpg8qe9SqM9dfl7_dGHBysrGkZPcAy8F/view
I listened to the audio of the oral arguments before the Supreme Court for the Tennessee case and thought most justices asked good questions about the rationale for minors seeking hormonal treatments. Justices Sotomayor and Jackson seemed rather clueless on the issue gauging from their questions and it gave me a bit of insight into why Harris lost to Trump. Progressive ideologues really don’t get just how profoundly stupid the idea of sex change is, especially when it comes to kids.
There’s an opinion piece in the WSJ on that case:
https://www.wsj.com/opinion/clementine-breen-lawsuit-transgender-medicine-center-for-transyouth-health-us-v-skrmetti-e22382f3
Archived:
https://archive.ph/JjXo4
I would think one of the most difficult factors to control in any study weighing the psychological benefits of puberty blockers against drawbacks would be the placebo effect. All treatments have a placebo effect, but an unusually high level of cheer leading (“We are now our AUTHENTIC SELVES and have never been HAPPIER!”) is almost certainly going to exert an additional strong influence on children avoiding puberty by undergoing the precursor to sex trait modification.
How do we accurately measure satisfaction rates? People studying detransitioners claim that most regret seems to sink in at around the ten year mark. That needs a longterm study on a young population which, in the meantime, is being damaged by side effects that are supposed to be oh so worth it because it’s oh so important to “pass.”
+1
This has already been mentioned.
Johanna Olson-Kennedy, where have I heard that name before? Oh yes, she is the person being sued (by Clementine Breen) for mutilating a child (age 14 at the time). The case is now a bit famous. Jesse Singal has reported on this case. This is (of course) part of why many people at BlueHair want to ban him.
Thanks for this Jerry. I probably get almost all my news from your links and the Free Press.
Thank you in particular for linking to the archived articles. I can’t subscribe to very many things anymore.
The Dutch study mentioned is what gave the world the “Dutch Protocol”, which as I remember, means puberty blockers at 13, cross-sex hormones at 16, surgeries at 18. That may be when the practice of puberty blocking in regards to trans issues started. Blockers had previously been used largely for precocious puberty and, I believe, as chemical castration devices for sex offenders.
It was instantiated in 2007 in the United States at Children’s Medical, Boston as “gender affirming care”, I believe.
Are all of you aware of the Niagara of death threats to journalist Jesse Singal after he joined Bluesky? Singal is one of a handful of journalist writing about gender issues competently and honestly….rare qualities in this field, especially the honestly part.
https://x.com/jessesingal/status/1868378941012275316
BTW,
After I listened to the audio of the Skrmetti hearing, I’ve started to question how much some of the justices even try to think through the issues in front of them (with reference to evidence and legal principles) rather than engaging in motivated reasoning (if I can even call it “reasoning”) of the most extreme kind.
In this particular case, Sotomayor stood out for seeming to just reflexively support or oppose certain arguments. Maybe it’s not always our “best and brightest” who end up there :).
A couple of my postings about this Supreme Court case:
https://carolinacurmudgeon.substack.com/p/dissecting-m-gessens-nytimes-op-ed
https://carolinacurmudgeon.substack.com/p/us-vs-skrmetti-can-tennessee-ban
Those were both very good.
And yes, I read to the end!
I also appreciate those essays; thank you.
I imagine anybody that was ever prescribed puberty blockers will have a pretty strong case to sue their medical providers? Especially now that the UK has banned them and Europe has put significant restrictions on them. A US doctor just can’t plausibly claim they didn’t know about the controversy.
But I’d say even before the pushback, there was never the evidence to support their use.
Sadly I think this is probably the only way to end the practice. The doctors still prescribing them and worse are ideologically captured. In fact they’ve demonstrated a failure to reason and assess evidence. They should be struck off.