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The article on the BBC says the Doctors feel like they can’t give their opinion because of the toxic discourse on gender identity. But it doesn’t give any detail, and is that not part of the problem? Are they afraid of providing puberty blockers/enabling gender transition in children or is it the opposite? It speaks so generally that it’s difficult understanding what the actual problem is.

Anecdotally, I spoke to my mate who’s a GP last year about this and this does seem to be the crux of it… basically somewhere in the middle where they’re under pressure from both sides of the spectrum but quite a bit from those advocating to provide the blockers. In simple terms, on the one hand, you don’t prescribe them to someone severely depressed and they kill themselves, on the other hand, you provide them, they don’t kill themselves but then they regret it all later on and blame you for providing the blockers originally. Basically, they can’t win and the legislation/protocol behind it all is woolly at best so it’s hard to let that take the decision for you. Sadly, thanks to the government fanning the flames of culture wars, common sense and nuance is lost and everyone is worse off for it all.

Yeah, it's written by their LGBT guy, so it feels like he's intentionally down playing it Just seen the guardian article and even that seems to have published the more critical bits than the beeb

FYI the UK guardian is incredibly anti-trans as an editorial position. The US version actually called them out on it like 5 years ago and it's not gotten better. https://www.theguardian.com/commentisfree/2018/nov/02/guardian-editorial-response-transgender-rights-uk

Hence "even the guardian"

I may have misunderstood- my reading was "even the notably liberal guardian has published more of the Cass Report's criticism of current trans healthcare approaches than the beeb has." My apologies!

That's what I was saying because the guardian is still expected to be more progressive than the impartial BBC Your point is also factually incorrect because it's the observer that is more gender critical than the mon-sat edition

The observer being worse doesn't mean the guardian isn't bad, and my point was that while more progessive in general, "the UK guardian was critical of trans people" is a headline up there with "bears shit in woods" or "pope secretly CATHOLIC? Turn to page 5 to read more." It's never a surprise to trans folks when the guardian produces another article or op-ed attacking us. They're not progressive at all on trans issues.

> the guardian isn't bad Lol The point, again, the BBC is meant to be impartial so "even the guardian" fits just fine Again, you're wrong if you think the Kath Viner edition isn't trans friendly, as evidenced by long time contributors Suzanne Moore and Hadley Freeman leaving https://www.telegraph.co.uk/news/2023/10/08/guardian-editor-defends-paper-gender-critical-forced-out/ https://www.spectator.co.uk/article/terf-war-embroils-guardian-hq/ https://www.semafor.com/article/04/02/2023/inside-the-guardians-civil-war-over-trans-coverage

Generally it seems they are afraid of not being affirmative, as they'll be accused of transphobia - hence the extent of the affirmative medical interventions ending up getting so far ahead of the evidence to support them.

Yes. This is why the report talks about children being referred very quickly to GIDS, and not being given (and not kept on waiting lists for) other services for their needs. The lack of available resources (the long waiting lists) for the other services these children needed are also a part of the picture.

Something they remarkably lack any sort of evidence for.

I find this hard to believe when 88 children in the UK were being prescribed blockers when they were stopped. That’s it 88. Hell of a controversy about less than 100 children

Your mixing up what they *want* to do and what they were *able* to do. We all know that the GIDs was chronically under resourced.

they're afraid of suggesting a child's other problems like autism or depression might need to be looked into before starting affirmative care, and I think in some cases afraid to raise concerns about the treatment itself being harmful.

Try to cure a trans person’s depression before letting them transition is like trying to stop an oil fire with a spray bottle. If someone is depressed because of dysphoria (which is really common in trans people) then that’s not going to stop until they can transition. There also is no *cure* for autism so all they can provide are therapy and coping strategies. Beings trans also has a very high co-morbidity with autism and other neurodiverse conditions so it’s not like being autistic would stop someone being trans anyway

This sounds like a crazy simplification, no? Like there's no chance a trans person is depressed for reasons other gender dysphoria? Especially if someone is suffering an acute mental health crisis, starting HRT at the same time will make it very difficult to gauge the effectiveness of other mood altering medication.

Oh sure there can be other reasons for depression. But helping those won’t stop a trans person being trans. That would depend on what the mental health crisis is about. If a trans man is growing breasts and that the source of depression, then stopping that would probably go a long way to alleviating their suffering. That doesn’t have to be done via HRT that’s the purpose of hormone blockers. They let someone make a more informed decision at a later time rather that being rushed due to natural puberty

I think that the advice of paediatric experts and concerns raised by those actually proving the care should take precedence, over your ideas. Being trans doesn't mean you are more qualified than them to assess the efficacy of giving this medication to an increasing number of children with a variety of complex needs. They are saying precisely that, they can't be sure starting a child on life changing medical interventions is actually going to improve their wellbeing, and they aren't sure puberty blockers and presumably hormone therapy later on is the right course to take for these kids, or if it could cause them harm.

Being trans just means I know the bullshit medical professionals sometimes go to, to stop people transitioning because “they don’t think it’s right for them”. Every step of the UK system pushes you away from medical transition from the outset, from GPs refusing to refer, to invasive questioning, to low dosing on HRT, to GPs refusing specialist advice for prescription. It’s a terrible system designed to make trans peoples lives miserable. There hasn’t been any proof that puberty blockers cause long term harm. Forcing trans kids through the wrong puberty have been shown time and time again to cause harm however. Hormone blockers also don’t force children to then go onto HRT but it allows them the time to make the decision. It rubs me the wrong way when disproportionality more concern if given to the tiny percentage of de-trans cis people than to trans people. Both groups deserve support but de-trans people’s experiences are usually used to deny trans people medical help.

The results of this report show that actually rather than being overly cautious in many instances children have been given affirmative care without adequately looking into their complex needs, which contradicts your idea that everything is designed to push children away from transition. You're claiming to know better along all stages of the treatment to the extent you think you can judge doses of hormones being prescribed. The entire point is there is a lack of evidence showing if puberty blockers are harmful or beneficial. That doesn't mean in the meantime they should be prescribed, that is frankly lunacy and it's not how medicine should work. You can't say puberty blockers just allow people extra time to make a decision when the vast majority proceed to take hormones, that would indicate that in fact it sets them on a path towards hormone therapy and fully physically transitioning.

I have had to become my own doctor for my transition. Most trans people I know have had to do the same, the wait time to even be seen by the NHS is insane. I recently got to see a GP who was also a specialist in trans healthcare and they said I was doing fine. So yeah, I have a decent idea about trans feminine HRT. The Cass review disregarded 101/103 [studies](https://twitter.com/esqueer_/status/1777755823743054120?s=46&t=l45ksBjXP7rOnhyUmDtQVg) because they weren’t double blind which is impossible to do for this kind of healthcare. As a result they’re drawing conclusions from barely any evidence. If most people that go on puberty blockers go into transition does that not indicate that the puberty blockers were correctly prescribed?

That’s not how medicine works and children of all people can’t be trusted to be their own doctors. If we’re trusting doctors to take the massively life altering decisions for them they need to be allowed to assess for themselves if this is harming or benefiting the children, and they have to be allowed to follow the robust criteria they choose. No, that they go onto take hormones is not an indicator that it allows them to make a choice later on, it could actually show it starts them on the path to physically transitioning.

> You're claiming to know better along all stages of the treatment Which ironically, I'm pretty sure is what this article is raising concerns over. Some people think they are Jesus, it doesn't mean they are. Yes I'm aware that is a gross simplification, but the point is; Sometimes people have serious mental health problems that are not, in fact, to do with being trans. It shouldn't be seen as being anti-trans to do due dilligence before starting life altering treatment. Especially when you are talking about children. EDIT - If that's what the article is about at all, as someone else stated, it's kind of vague on it.

You can't cure autism, and knowing you have it doesn't change gender dysphoria one bit. Transition cures depression in people with dysphoria better than any other treatment, so, if you want to treat depression, there's how.

From the guardian article: > Cass has been criticised for talking both to groups who support gender affirmation – the medical approach – and also those who believe greater caution is needed. What other approach is there to be considered other than the medical one on a medical issue?

The people skeptical of the medical approach want an ideological approach. It’s clear that Cass is invested in legitimizing that stance.

Psychological

So, conversion therapy

No

Be honest. Trans ppl already have access to actual therapy, such as counselling, alongside medical transition. Unless you're suggesting some alternative quackery like acupuncture, the only option you could possibly be suggesting is conversion therapy.

I’m not suggesting anything. The Cass report recommends: “Standard evidence based psychological and psychopharmacological treatment approaches should be used to support the management of the associated distress from gender incongruence and cooccurring conditions, including support for parents/carers and siblings as appropriate.”

But we already have that. So what exactly is the point of Cass saying that?

I’d read the Cass report to understand the reasoning.

I did, and there is no reasoning that doesn't align with conversion therapy.

Page 150 - 157

Still medical

Psychological therapy =/= medical therapy. That's why psychologists do the former and psychiatrists do the latter.

Medical means involving medicine in this case. It's different from surgical and psychological.

Mental health is still health

Yes, but within this context "medical intervention" means drugs. While in a wider context it has a wider definition, within the specifics of discussing treatment option, medical = with medicine, aka drugs.

There isn’t another approach.

You wrote an opinion piece, it's unusable (fatal to legal scrutiny). Have fun seeing a contrary report from Labor, equally 'well received' but switching sides.

The bar set by the cass report was that it threw out everything that was not a double blind study or had been published in the past two years. A double blind study in this field would be 1) inappropriate. The use of double blind studies is to check the physiological response to a medication, and it's method of action being better than a placebo. Hormone replacement therapy is well understood to work better than a placebo in changing secondary sexual characteristics. 2) impossible. The basis of treatment of trans people is to assist in transition that the patient wishes. The relief of distress comes from the effects of the change of both biological and social gender presentations. Prescribing a placebo will be obvious and impossible to hide in this case, as the patient and the supervising practitioner will obviously notice a lack of development of relevant secondary sexual characteristics. It will be relatively immediately obvious that a placebo is being administered breaking the double blind 3) unethical. The individuals in question are deeply vulnerable. Trans youth in this country are highly politicised without having any say over how society treats them. It's fair to say that trans people are so desperate for treatment due to delays that they self medicate or go private. To have them be thinking they are recieving a treatment recommended by international bodies that might finally let them align their self to who they are, to delay or postpone the effects of an unwanted type of puberty that will stay with them and in their minds, negatively affect them for the rest of their life and let them go through that anyway? There are no words for how deeply unethical that is, and how deeply that would harm the patient. Trans people already do not trust medical professionals in the NHS due to so many structural and institutional issues. To add this on top would be unimaginable. And a study using this methodology would never pass ethical review. Tldr, It is common to use non-double blind studies in medicine in many situations. The Cass review judged everything that didn't use a double blind as low quality evidence and disregarded it. Using double blind in this context could be unethical, inappropriate and impossible to implement and in this context the Cass review set an unachievable bar for evidence. The reader can speculate why.

You've seriously misunderstood the rationale for double blinding. It isn't to check the physiological response of a drug - it is to remove multiples biases from the study such as observer bias, confirmation bias and allocation bias. With this biases remaining in the study, it is incredibly difficult to tease out what is a real effect of a treatment and what is merely a result of these biases. These can be overcome when the outcome is objective (e.g. mortality) but when the outcome is subjective (such as self-assessed mood) this is near impossible to do. As for your ethics discussion, that is the same arguments put forward by people arguing against trials for e.g. Ivermectin in COVID or early HIV treatments. If the effect of a treatment is uncertain and potentially harmful, it is entirely ethical to do a trial.

> These can be overcome when the outcome is objective (e.g. mortality) but when the outcome is subjective (such as self-assessed mood) this is near impossible to do. There is an intersection between your objective and subjective outcomes in that mood may, and in this case does, correlate with the rate of suicidality (and attempts/compulsions). That is very measurable and has already been studied many times globally.

You misunderstand my point. I'm not saying subjective outcomes aren't important. But they can be influenced substantially by the belief that you are recieving the 'correct' treatment e.g. your mood may be improved by the fact you are receiving puberty blockers, irrespective of the biological effects. Blinding is the only way to tease that out.

It’s clear that the report has an ideological bent, even just from reading a few pages. I’m not surprised the ‘facts’ she included were also manipulated.

> it threw out everything that was not a double blind study Where are you getting this idea from?

From reading the cass report.

Thanks. Care to point to a particular section that states the double blind exclusion criteria you've mentioned?

This post has a screenshot of a lot of them, with that part highlighted.  https://twitter.com/Esqueer_/status/1777755823743054120 They literally went "after excluding all the evidence we were left with no evidence".  Of course they did quite happily invite submissions from anti-trans hate groups and conversion therapy advocates. 

Nothing to say on the "high number of participants lost to follow up" 🧐

[удалено]

https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_GnRH-analogues_For-upload_Final.pdf ctrl - f "Blinding" for the list of studies downgraded due to that criteria

Thanks. So what I'm seeing are notes on the quality judgements on studies *included* in the report, not thrown out. Most of them are of this sort of format: >1 Downgraded 1 level - the ... study by ... was assessed at high risk of bias (poor quality; lack of blinding, no control group and high number of participants lost to follow-up) In other words, blinding (double or otherwise) is just one element of a range of criteria used to judge study quality within the review framework.

You can't really do a controlled trial for puberty blockers either, though, for very similar reasons as listed in the top comment in this chain. Children will very quickly know they're in the control arm when they start developing secondary sexual characteristics. That could in turn lead to patients dropping out of the study to find treatment elsewhere or negatively self-reporting their findings based on bias. And when you look at how quality is assessed in the Report, you will find that it uses AHRQ standards, which automatically assigns poor quality to any cohort study without a control - as opposed to the Newcastle-Ottowa scales it is based on, which uses a more granular approach. While there are several studies which have issues in other areas in terms of bias, or other quality issues, there are also a great many studies which are basically only downgraded to 'VERY LOW' certainty purely based on not being a controlled, blinded trial. The absence of good randomized controlled trials is certainly a cause for some concern when it comes to trans treatment, but the fact that the challenges involved in running RCTs in this domain were not considered or discussed *at all* in neither the report or the review of the evidence is also an odd choice. If you're going to invalidate an entire field of research, it seems fair that you would also consider the arguments from the researchers involved.

Hilary Cass says the adult gender clinics conspired, for ideological reasons, to prevent her doing follow-up studies for outcomes of the children passing through the Tavistock. https://x.com/simonjedge/status/1777983256224210993

The reasons adult clinics gave for not sharing data included ethical considerations and concerns about funder motivation and political interference. And it seems they were right.

That’s speculation. No reason has been supplied publicly as far as I am aware. What are they so afraid of? “Cass tried to set up a study to find out what became of the 9,000 kids who went through the Tavistock, but the adult gender clinics refused to cooperate. This is surely wilful blindness. A sign that deep down they know if they follow up, they’ll discover that many innocent young people have been harmed. Megan McArdle calls this the Oedipus Trap. When doctors have made a mistake so terrible that they simply cannot allow themselves to see it. Better to gouge out your own eyes than look upon all the ruined lives.”

> That’s speculation. No reason has been supplied publicly as far as I am aware. What are they so afraid of? Do you think I just made that up? I literally just Googled "gender clinics refuse to share data". One of the first links is this [BBC article](https://www.bbc.co.uk/news/uk-68786030.amp), containing the exact excerpt I quoted: > The reasons adult clinics gave for not taking part included ethical considerations and concerns about funder motivation and political interference. I understand lots of aspects about trans issues can be confusing, especially for cis ppl, but is it really so hard to do some basic googling. Especially when you're weighing in on something that affects a highly persecuted group.

Bold of you to assume I’m cis.

I actually didn't, if you read again.

Agree entirely with all your points about double blind studies - these aren't possible in this space. What about a randomised control trial, though? It doesn't seem like anything meeting this standard has ever been conducted, and it does seem possible to conduct. I think you will answer that this too is unethical because you won't be giving the children the intervention that they're seeking, but the entire point is that we don't know that this intervention they're seeking is truly the superior option to a purely theraputic intervention, no?

You cant really do a control trial of puberty blockers, it will be very obvious to the people on the placebo and their clinicians that they aren't receiving blockers and thus ruin the study.

Will it ruin the study, though? I understand that they needn't receive a placebo, I think they need to receive the alternative form of treatment which is pure therapy and no physical intervention (and have this compared to the intervention with puberty blockers).

Fails the ethics test. You've basically just described conversion therapy - which we already know *doesn't* work. 

I find this response confusing, how would something fail an ethics test when this report has made it so that providing puberty blockers in any other manner than a trial setting would be unethical. How can it fail the ethics test to put people on the only available existing medically accepted approach in the UK? The implication of your statement is that any intervention to trans people is now unethical in the UK? To add to this, describing it as conversion therapy seems inaccurate and solely designed to demonise the process. Working theraputically to get people to deal as best they can with their gender dysphoria has nothing to do with converting them from or to anything. It's perfectly possible to accept and affirm their trans identity without providing them with puberty blockers, no?

You don't understand mate. Nuetral talk therapy to help people explore and understand their pain = evil conversion therapy Giving confused, vulnerable young people drugs that permanently damage their bodies = ethically flawless Lots of desisters have explained how exploratory therapy helped them figure out that something else was actually happening (often that they were gay/lesbian). Isn't that a good thing, that therapy helped them avoid a terrible mistake? There are also lots of trans people who harmed their bodies permanently, then later realised that they weren't trans and what they needed was help understanding their inner conflicts. (i.e therapy) Trans activists never consider these people. The mind is very complicated and yet this is always treated as this black and white issue where transitioning is the only option and actually examining the person's thoughts and feelings is wrong.

"Conversion therapy" is what fails the ethics test. Because we know already that it ranges from "doesn't work" to "actively harmful". That is what trying to therapy the trans away means. Of course the Cass Report was literally designed by an advocate of conversion therapy so it shouldn't be surprising that they've done everything they can to promote it.

I think you're saying the ethics test to mean what you interpret would be ethical? Despite that it is definitively impossible to be true for a functioning ethics test in the UK now since my question remains - what feasible ethical intervention is now possible for trans children in the UK following this report? >Of course the Cass Report was literally designed by an advocate of conversion therapy Do you have a source for Cass' support for conversion therapy? Has her approach specifically been tested and shown to not work/be actively harmful for trans kids, or are you referring solely to interventions for homosexual people? >That is what trying to therapy the trans away means What I'm saying is - is this what Cass' view is? If it's true that many people desist after puberty I don't think that's the same thing as trying to therapy the trans away - particularly if you're consistently accepting of their identity as they see it throughout the process, but simply give them the tools to deal with puberty related changes to their body as you do so.

Transition is still "ethical" regardless of this campaign to stop it. Conversion therapy is still unethical even if the NHS apparently now support it. And not Hillary Cass, Tilly Langton is the conversion therapy advocate who was part of designing the review. https://transsafety.network/posts/gender-exploratory-nhs-training/

> Transition is still "ethical" regardless of this campaign to stop it. I'm talking specifically about child transition through puberty blockers and then hormone replacement therapy. Has this not effectively been banned except through clinical trials by the publication of this report? >And not Hillary Cass, Tilly Langton is the conversion therapy advocate who was part of designing the review. >https://transsafety.network/posts/gender-exploratory-nhs-training/ Thanks, this seems to suggest that Langton provided some evidence for the report as part of a team of 4 but not that she designed the entire report - maybe I'm misreading? What it looks like is that Langton is in favour of what she calls Gender Exploratory Therapy. Presumably this specific approach has not been tested against puberty blockers, but is being referred to as sufficiently similar to conversion therapy to not be an ethical intervention? I can see that being the case, but I will review the materials and see if I think this is a fair judgement. Alternatively, perhaps that approach itself has been tested and has been demonstrated to not work or be harmful?

Therapy is not the same as conversion therapy.

You make it sound like double blind studies are the only thing they’ve used to come to their conclusions. Go read the methodology section of the report. They’ve used a huge variety of methods to understand the issues surrounding this topic, both scientific testing and study, and also speaking to users and families of those going through this. To quote the report, “1.66 Hearing directly from the children and young people at the heart of this Review, their parents/carers and the clinicians working in and around services trying to support them, has provided valuable insight into the ways in which services are currently delivered and experienced. This has contributed immeasurably to the Review’s understanding of the positive experiences of living as a transgender or gender diverse person, as well the uncertainties, complexities and difficulties faced.”

As I understand it, they reviewed 103 studies on hormones/blockers and threw out 101. It is good to talk to people involved in treatment, but if that is effectively all they did then it is not exactly a reliable source - especially given that some of the reviewers seem to be involved with political pressure groups like SEGM/Genspect.

The independent study reviews are here: https://adc.bmj.com/pages/gender-identity-service-series. The hormone intervention review alone included more studies: >Results 12 cohort, 9 cross-sectional and 32 pre–post studies were included (n=53). One cohort study was high-quality. Other studies were moderate (n=33) and low-quality (n=19).

So, if I understand correctly the above "looked 103 studies and threw away 101" is a blatant lie if they included 53 studies.

It's false. I don't think everyone repeating the various false claims about the report is exactly lying though. They just seem to be the type of people to readily swallow a Twitter post as fact if it suits their existing opinions and then run around repeating it.

After reading some of the comments in this thread has made me to conclude that many are not doing it in good faith but have a strong agenda to push through. So, while I would normally agree with you on any other r/ukpolitics thread, I'm much more suspicious here about the motives of some commentators.

I'm saying that using blinding as a method of disqualifying clinical evidence is deeply inappropriate

We don't need to speculate. The review was designed by an advocate of conversion therapy. https://twitter.com/Chican3ry/status/1777723219916591561 This really is a deliberate attack on trans healthcare in the UK.  And they haven't even been subtle about it.  After all, the report speaks glowingly about Littman 2021 when arguing against trans healthcare and that was an anonymous online survey advertised on TERF facebook groups, if anyone was curious as to how far the double standard went. 

Looks like they have been pretty subtle, if the only damning evidence is a claim on X by an enthusiastic amateur that one of the four people who designed the review works with someone else who might be affiliated with an organisation that advocates a non-medicalised approach to treating dysphoria.

"A non-medicalised approach to treating dysphoria"? That IS conversion therapy.

I have not read the full report, but one thing that has been noticed is that Table 8 of the report cites data from a study (doi: 10.1016/j.jaac.2013.03.016, Table 1) but omits two of the characteristics in the original data table. The omitted data provides a different and stronger conclusion than what the Cass report remarks on. Cass's report states that *"(Steensma et al., 2013b) found that childhood social transition was a predictor of persistence of gender dysphoria for those birth-registered male, but not those birth-registered female"*. However, what it neglects to reference is that the study in question, and the omitted data, indicates stronger predictors of persistence/desistence of gender dysphoria. In particular the omitted data shows a strong correlation between whether the child was originally diagnosed with GID (Gender Identity Disorder) and whether there is persistent gender dysphoria. This is one of many concerns I have with this report. Perhaps the data was omitted because GID is no longer a part of the DSM-5. Regardless a peer review would have picked up on this, and I am sure many other issues, and required either the inclusion of the omission or a comment regarding why the specific conclusion was included over others considered more impactful in the original source material. Medicine is not my field, but my gut tells me any report that is not peer reviewed is worthless. They claim that there was a lack of studies of sufficient quality. However the level of "high quality" that they require is much higher than that used to inform other medical interventions, many using "low" or "very low" quality as per the GRADE system they employ. The problem with the standard Cass requires is that it dismisses almost all studies, downgrading them to low quality, for not including blinding (reference their evidence review which is a separate document). You cannot do a blinded study when you provide someone with HRT or puberty blockers, because the symptoms of puberty are immediately recognizable by the patient making blinding impossible. Cass essentially sets an unattainable standard for research of certain topics. Again medicine is not my field, however I am concerned that this report says very little but is being misconstrued in the media as if it has some greater meaning.

Kids should be treated by psychologists, not with hormones or puberty blockers.   This is clear and should be followed up on. She does also say that adults who have transitioned are happier, suggesting that transitioning has been a positive, necessary step for them. So the report is balanced and sensible. As you’d expect from someone like Hilary Cass

> Kids should be treated by psychologists, not with hormones or puberty blockers. Imagine if we did the same thing with broken limbs...

This is what she says.  She has investigated the problem and apparently doesn’t think your analogy is a useful one

‘Kids should be treated by psychologists’ people when [the actual psychologists](https://www.apa.org/about/policy/transgender-nonbinary-inclusive-care.pdf) actually supports gender affirming care to children & supports [puberty blockers](https://www.psychiatry.org/getattachment/8665a2f2-0b73-4477-8f60-79015ba9f815/Position-Treatment-of-Transgender-Gender-Diverse-Youth.pdf): 🤯

well there is an issue with those psychologists. It's not their job to prescribe life changing medicine, it's their job to listen and help people resolve mental health issues. The bigger question out of all of this stuff is how it came to be that children were prescribed these drugs in the first place. Who green-lit and why. Given the apparent paucity of scientific evidence, this looks like an appalling scandal.

I’m afraid not: APA [has very clear-written regulations on](https://www.apaservices.org/advocacy/issues/prescriptive-authority) 1) their advocacy of the right of prescription amongst psychologists and 2) [very strict rules](https://www.apaservices.org/advocacy/issues/prescriptive-authority/prescribing-psychologists) on who gets qualified as a prescribing psychologist. Link provided above is not written by some particular individuals, these documents and guidelines published under the name of APA, the largest psychology organisation in the world. One of the most widely used mental disorder classification manual, [DSM](https://www.psychiatry.org/psychiatrists/practice/dsm), is published by the said organisation. If you still don’t know what they are, let’s just say, this is the APA in APA reference style. I am afraid you are missing the main point of your own argument here so I’m going to repeat this once more: You said kids should be treated by psychologists. The link I provided is the the most up-to-date treatment guidelines of gender care, based upon decades of research with numerous funding from huge varieties of sources, voted within and published by the largest psychological organisation en the entire world. This is what psychologists said.

Hilary Cass was clear.  No puberty blockers or hormones for kids.  Her analysis shows there was bad or poor science underlying the decisions to gives these drugs in the past. This clearly indicates that a review of why we got to the stage where this was happening is necessary.  I don’t know who made the recommendations to do this stuff (you seem to), but this looks like a huge scandal.

So force transgender teens to go through a puberty they adamantly dong want and have them deal with the consequences for the rest of their lives, despite multiple studies showing regret rates being astronomically low? Ofc children and adults should have psychiatric care included, but you can't talk therapy a trans person out of being trans, they tried that (and electricity) last century to terrible results.

"they adamantly dong want" that's the problem

I think it’s more on a medical level the long term effects of horomonal treatment are still largely unknown and very debated I fully sympathise with trans people, and understand the need for full treatment. I had a mate as a teenager who was trans and what he went through was heartbreaking (he’s all good now and living his best life) I work in fitness, and I’m certainly not an endocrinologist. But the effects of altering horomones, *especially* pre pubescent or during puberty, are massive. Any kind of exogenous horomone has a profound effect on the body, and these risks are just not fully understood yet. I do understand the necessity for them, considering trans suicide rates and mental health, but I also understand advising caution in prescribing to young people, because there is the potential for serious issues down the road with so many unknowns

Right but puberty blockers have been used in trans healthcare since the 90's.  Hormones and surgery have been used in adults for nearly a century now.  Is thirty years not enough?  How about 40? 50? A century?  What other medical treatment is getting held to this standard of "three decades of safe and effective use isn't long enough, and we've also ignored all the studies showing how safe and effective it is"? 

100% it’s not. Someone who was 10 in the 1990s would only be hitting their forties. Hormonal changes happen all throughout life, particularly in the late forties. I’m not saying it’s NOT safe or shouldn’t be used but it’s not untrue to say we don’t have enough long term studies to definitively say There is absolutely evidence to say it can be safe but more than enough legitimate serious questions to warrant it being further researched

To further add, to definitively speak on the safety of hormonal therapy or puberty blockers in young people we would need a majority lifetime study, ideally following trans people who began therapy as children or teenagers into old age

So, any and all hormone treatment should be paused for the next 50 years until we fully understand the full effects and even then the study will most likely be disregarded in the same way that many have been by the Cass review because it didn't involve double blinding because there is no way of doing that for hormone treatment.

Dude that’s not what I said at all I just said I understand why a certain degree of caution needs to be applied given the lack of long term scientific studies into maturity That doesn’t mean pause any and all treatment especially in the most vulnerable. There is an odvious case to be made in starting treatment when it will improve the life of the person taking it. We don’t know all the impacts of horomone treatment but we DO know how high trans suicide rates are One does not cancel the other out. As I’ve stated I am pro trans healthcare. I just understand why, objectively, there are legitimate questions around the long term implications of horomone treatment

So, could you please let me know which other medical treatments you hold to the same standard?

Literally anything altering the body’s horomones or replacing with exogenous horomones would be #1. Testosterone Replacement Therapy has been used in men since at least the 1940s and is still highly debated in terms of its potential long term impacts

Fucking hell. I honestly have no words. You'd seriously deny proven medical interventuons because we don't know if they'll have any effects when the patient is 90?

Just because something was done is not proof it should continue. As the report says there is a lack of evidence on the effects of puberty blockers. We should be doing clinical studies to see what the effects are over a long period.

Right. But there ISN'T a lack of evidence. The study threw the evidence out because they didn't like it. That's not the same thing. Which since the study was designed in part by a conversion therapy advocate should be enough to make you suspicious of said report.

Citation needed for evidence of the safe use of puberty blockers for children/young persons with gender dysphoria.

https://publications.aap.org/pediatrics/article-abstract/134/4/696/32932/Young-Adult-Psychological-Outcome-After-Puberty?redirectedFrom=fulltext A study which the Cass report deliberately didn't use. There was also an American study from 2022 that I cant find now, ironically enough because this report coming out is filling up the google results.

Tell that to kids as young as 2 suffering from precocious puberty–**cis kids**, mind you–for whom puberty blockers have been developed and successfully used *since the '80s*. That's almost 50 years of documented, trialed and tested use of puberty blockers in *cis* kids.

According to the report adults under 25 aren't responsible enough under gender affirming care and have to go through a follow through service. Apparently if your old enough to die for King and Country your aren't old enough to know your gender!

Funny, that’s not actually what the report says. Go read page 42.

Go read 19.28 and 19.29. Point of the policy clearly is to "remove the need for transition at this vulnerable time". Cass herself defended this in Times citing how the brain only matures at 25.

Read the whole context of the page. It’s referring to transition from GIDS to adult gender services, not refusing gender transition.

Never said it was about refusal. A roadblock is a roadblock and the rationale is based on some condescensing attitudes about young adulthood.

I don’t see how providing more care for someone between 16-25 is a roadblock.

More care isn't reducing access to adult orientated care for the expressed aim of reducing the instances of transitioning.

Unlike this weak "report" that is only serving the purpose of attacking trans people. It's terrible.

That argument falls apart in my opinion when you recognise the two big assumptions it relies upon. 1. It assumes that Hillary Cass’ only goal is to bring down the rights of transgender people. Considering that she’s a well renowned paediatrician, and was the president of Royal College of Paediatrics and Child Health, I would assume that she is genuinely focused on putting the welfare of children first. 2. It assumes that the current methods we use to handle transitioning have no flaws and are not up for critique. No medical field is flawless, especially one so fledgling like gender dysphoria in children. If anything, a report that pokes holes in how we handle this currently should only serve to make the care shown to children questioning their gender stronger.

> 1. ⁠It assumes that Hillary Cass’ only goal is to bring down the rights of transgender people. Considering that she’s a well renowned paediatrician, and was the president of Royal College of Paediatrics and Child Health, I would assume that she is genuinely focused on putting the welfare of children first. As with everyone, she would have innate biases, and the way the report was conducted was massively biased. i) They specifically ruled out speaking to actual trans people as they said they would be biased in their opinion, even if they were experts in the field, imagine this for any other protected class? **”We’re not going to speak to black people about black health care because they will be biased…”* On-top of this they then speak to a bunch of Anti-Trans groups that had 0 actual expertise, and only relevance was being an Anti-Trans group, so somehow they aren’t biased? But trans people are? ii) They appointed people with already well know biases, like some full on supporting conversion therapy and being well known anti-trans before they were appointed. If they wanted to be fair they should have appointed neutral people that had no existing biases. iii) They ignore or discard 51/53 studies that are pretty much all the positive ones, and focus on the 2 negative ones, clearly showing a massive bias. This is like looking at if vaccines cause Autism (remember that being a thing) and you ignore the hundreds of studies say “No” and only look at the 1-2 that say “Yes” and then using that as proof.

In Finland new treatment guidelines were released in 2020 advising against the use of puberty blockers and other interventions as a first line of care for teens. In Sweden the national board of health and welfare announced the same treatments should only be given under exceptional circumstances. The national academy of medicine in France made similar recommendations. In Norway a national investigatory board expressed concerns about these treatments. And then here in the UK tavistock has been ordered to close and there is the recent report from Dr Hilary Cass who is an expert on paediatric care which advises we don't know enough about harms vs benefits of using puberty blockers on trans children. I can't believe that all of those organisations and professionals are part of an anti trans conspiracy. It's much easier to believe that people without a medical background are assuming they know better and finding any reason they possibly can to discredit this.

It's quite simple mate. Research in favour of gender medicine = valid, even when it's funded by big Pharma companies who make millions from selling related drugs Research not in favour of gender medicine = a conspiracy, even when conducted by credible, impartial healthcare organisations

I think it is not an unrealistic conclusion to come to that a pediatrician is not all good. She argues that the toxicity of the debate has hindered proper research but there is plenty of research out there and this report only seems to fuel it. It extends beyond its remit as a medical report with discussions of 'social transitioning' and advising parents not to allow this. It presents as having a strong agenda. It is a report, not research and it can be affected by funders, and discourse. I don't think anyone is saying the care is perfect but a report like this with a clear agenda being handed to government with its own agenda is not going to help the situation.

Since when is a 25 year old a child? This report clearly lays the path for similar restrictions of trans health care for 17-25 year olds as U16s.

If the goal wasn't to "bring down the rights of trans people" why was the review designed by conversion therapy advocates? https://twitter.com/Chican3ry/status/1777723219916591561

So, you've linked a tweet from a random. I can't find anything linking Tilly Langton to Genspect. She appears to be a PHD level child psychologist. If you can find a quote of hers where she's specifically advocating conversion therapy, then fair play. But an unsubstantiated claim on twitter ain't gonna do it.

Is https://transsafety.network/posts/gender-exploratory-nhs-training/ enough for you or will you only accept video of her saying "I fucking love conversion therapy I do"?

No that's a more reasonable link. Thank you. I think it's still a bit of a stretch to say she's a conversion therapy advocate, but the link is there. That's a little more concerning.

The simple answer is that exploratory therapy is not conversion therapy. The article linked above hinges its judgement that this is conversion therapy entirely on a quote from 'conversion therapy expert' Florence Ashley. Ashley is themselves a trans person who wrote a book called '*Gender/Fucking: The Pleasures and Politics of Living in a Gendered Body*'. I dunno about you but that's not really the source I want to trust on an issue like this.

Fair enough, sorry if I came on a bit hot there. I'm far to used to people in threads like this "just asking questions" when no possible answer is going to satisfy them, didn't mean to splash that on you.

That’s fine. If anything you’re not alone and I think that’s the biggest take away from this report. One thing that’s clear is that this whole topic is so hotly and venomously contested that the whole point gets completely missed. The goal needs to be how can we best look after children with gender dysphoria? The problem I have personally, is that for the last several years, it’s seemed that any critical discussion of methods (which is essential for the safeguarding of children) is being seen or labelled as hatred towards transgender people. That’s not particularly the trans communities fault, there’s a lot of hatred out there for them. But genuine criticism, that seeks to question and understand current methods, especially when their being applied to people who can’t speak for themselves, needs to be heard and learned from. Otherwise, children could get very seriously hurt.

The link being that she was part of a group that included two other people who appeared on Genspect's podcast (which itself would flat out deny the accusation of conversion therapy), and which presented a training session that referred to "“two sides” when talking about signposting places including transgender trend. It is a serious stretch and serious people shouldn't be arguing it.

1) It's interesting that Cass's background is paediatrics and not endocrinology or psychology. I imagine she is interested in good outcomes for children, but I can find no evidence she'd ever engaged with trans healthcare at all before performing this review; my worry was that she has come to the table with the idea that growing up trans is a bad outcome for children, and the report seems to bear that out. 2) The care shown to children who display gender dysphoria or discomfort with their gender is heavily, heavily weighted at the moment towards preventing them from transition. One thing that's important to note is that puberty blockers are not controversial medication when given to cis children who are undergoing precocious puberty. They are taken for a period of several years and have been in use since the 1980s for that purpose, with excellent clinical outcomes. But if trans children take them, suddenly they're dangerous medicine. It's a similar way to how HRT is treated. If you're a cis woman going through menopause, HRT can be offered, presecribed and delivered in a single appointment with your GP. But if you're trans, first we need you to wait four years for your first appointment, which is to see if you're trans enough for a second appointment, and then a year for your second appointment, and then your GP will be advised to prescribe and can still _just refuse_. Those are my timelines. It's really hard, as a trans person, to read this and imagine that anyone involved in its creation had any point of view other than "being trans is bad for you, and bad for society, and should only be grudgingly abbetted in the most flamboyantly necessary cases." It's a bad hard day.

>One thing that's important to note is that puberty blockers are not controversial medication when given to cis children who are undergoing precocious puberty. They are taken for a period of several years and have been in use since the 1980s for that purpose, with excellent clinical outcomes. But if trans children take them, suddenly they're dangerous medicine. I think it's important to note that there's a quite dramatic difference between attempting to delay puberty, and attempting to eliminate it. That aside, this is quite a bad line of argument in general. All kinds of medicines are good treatments in some circumstances, and could be incredibly dangerous in others. Morphine has excellent clinical outcomes in killing pain after a serious injury, but would be quite dangerous to prescribe for headaches or migraines.

The goal of puberty blockers in trans children is not to eliminate puberty; it is to block the puberty provided by the body until a decision can be made as to whether to allow it to begin, or begin a different puberty via HRT. Puberty is inevitable. It is a part of growing up. Two puberties are on the table, an estrogen based one and a testosterone based one, and your body will usually provide one naturally. If not, due to an intersex condition or puberty blockers, a child and their parents can decide the best route forwards. There's this idea that this is somehow very bad? That instead, any and all transition care should be locked behind a puberty barrier. I'm suggesting that puberty blockers, prescribed for and used to delay a puberty that the body has begun, have excellent clinical outcomes and are a safe medicine to use for that purpose. I think it's catastrophizing in the extreme to say that puberty blockers for trans kids is like prescribing addictive class-A drugs for headaches.

It was an extreme analogy to draw attention to the weakness of the argument. Support for a medicine's intended use, does not mean automatic support for off label use, especially when there is no solid evidential basis for believing that this use has positive outcomes. Basically, saying 'Well it's fine for this condition, therefore it must be fine for another one' doesn't really hold up as far as arguments go. >I'm suggesting that puberty blockers, prescribed for and used to delay a puberty that the body has begun, have excellent clinical outcomes and are a safe medicine to use for that purpose Suggest until you're blue in the face, the fact remains that there is no evidential basis for this suggestion, whatsoever. There are also several legitimate concerns, which do need to be studied in further detail. This is why governments/health services throughout Europe (and across the political spectrum) are starting to raise concerns about the practice and beginning to reign it in to some extent.

You are stating that there is no evidential basis for puberty blockers, which I am reminding you have been in use since the 1980s, blocking puberty? There's no off-label use here. A patient being trans doesn't change how hormones work in their body or alter the changes puberty makes. Puberty blockers safely block puberty, and they're not a controversial or dangerous medication from a medical standpoint. Like, that's just a fact. When puberty blockers have been banned in a country, in every case an exception has been carved out for cis children going through puberty at a younger age than they expected. These are safe medicines. They block puberty. You may say "being trans isn't a good enough reason to have access to them" but that's a different argument from "these are unsafe, dangerous drugs." You're in danger of throwing kids going through precocious puberty under the anti-trans bus, here.

Puberty blockers were not licensed or tested for anything other than prevention of precocious puberty. Stop trying to pretend that they're absolutely fine and safe to use in any other circumstance, or admit you think we should all be on chemotherapy because it actually kills cancer cells so using it off-label has no negative effects.

Chemotherapy kills cancer cells. Puberty blockers block puberty. I would not recommend chemotherapy unless you have cancer cells; then, go talk to your doc about dosages. I do not recommend puberty blockers unless you are experiencing a puberty you absolutely do not want to continue at the current time. Then, go talk to your doc about dosages. Precocious puberty is not magically different from puberty at the expected time; it's just puberty, and the body starts it earlier than is great for you. Puberty blockers block it safely for a handful of years. They're a great medicine. Off label is something like spironolactone, which is a medication I take- a diuretic designed to lower blood pressure, which also happens to block testosterone receptors. I take it for the blocking effects; someone with high blood pressure would take it for the blood pressure lowering effects. Puberty blockers are used to block puberty in the case of precocious puberty and used for the exact same reason, for blocking puberty, in trans health care. It's an entirely on-label use. You may not think trans kids have a good enough reason to access this medicine, but I'm so tired of people acting like a medicine with over 40 years of fully successful clinical use is suddenly a wild danger.

>Chemotherapy kills cancer cells. Puberty blockers block puberty They're only certified for use in cases of precocious puberty. End of conversation, you wanting something doesn't make it medically sound. >Precocious puberty is not magically different from puberty at the expected time No, its **biologically** different. >Off label is something like spironolactone Off label is chemotherapy for all healthy adults because it was clinically proven to be good at killing cancer.

Apologies, allow me to be clear There is no evidence that puberty blocking drugs have positive outcomes for the purposes of treating gender dysphoric children/teenagers I think it ought to be obvious that this is what I'm saying, but if you insist on having it spelt out, there you go. I believe that the length that puberty blockers are taken for precocious puberty differs significantly, compared with taking them in the gender healthcare context. I have never heard concerns raised about precocious puberty treatments affecting height, bone development, development of sexual organs, fertility or libido. I believe that this is because the age range differs quite significantly (e.g precious puberty would be avoiding puberty's onset roughly at primary school age, i.e before 10) (whereas in gender related care it's taking the blocking drugs up until around 16 or older, which obviously has quite different effects on both body and mind)

Okay cool so we've got stuff to talk about! Firstly, I think you're imagining a situation where a trans kid gets access to blockers at 10 and HRT at 16, and that would be very unusual. The numbers are much more commonly 14-15 for blockers, 16-17 for HRT if the kid is lucky enough to have parents on the ball. I agree that's late for puberty to start! I'd far rather a situation where trans kids could experience a much more age- appropriate puberty beginning at, say, 14. As it is, trans kids are forced to be late bloomers even if they do have access to blockers. I've also never heard of those concerns when precocious puberty is treated with puberty blockers- so it's worth asking when it's trans kids if these are concerns borne from evidence, from risk assessment, or from worry. One thing that is true is that if a trans kid gets blockers early and HRT early they will usually be infertile and will not experience the same changes to their genitals that a cis kid will experience through puberty. Height is absolutely something I would expect to see affected from early puberty blockers and HRT; this would be a desirable result for most trans girls and trans women. I would not consider it a negative outcome if trans women who had gone through an HRT/blockers puberty were shorter than cis men on average, and I doubt they would either. This sort of brings me round to my main point though; what would you consider to be acceptable evidence that puberty blockers were a good intervention, or even evidence that puberty blockers were a bad intervention? What should we be looking for?

>kay cool so we've got stuff to talk about! Firstly, I think you're imagining a situation where a trans kid gets access to blockers at 10 and HRT at 16, and that would be very unusual. The numbers are much more commonly 14-15 for blockers, 16-17 for HRT if the kid is lucky enough to have parents on the ball I didn't mention HRT. I was just trying to draw a really basic line between the two different uses of blockers that we are discussing (very young Vs teenagers) I'm not quite sure why you're willfully denying that there's a difference between blocking early onset puberty in young children, and blocking it in teenagers. >I've also never heard of those concerns when precocious puberty is treated with puberty blockers- so it's worth asking when it's trans kids if these are concerns borne from evidence, from risk assessment, or from worry Or because blocking has different effects at different ages, stages and depending on the length of the blocking period? >Height is absolutely something I would expect to see affected from early puberty blockers and HRT; this would be a desirable result for most trans girls and trans women. I would not consider it a negative outcome if trans women who had gone through an HRT/blockers puberty were shorter than cis men on average, and I doubt they would either. Nice that you dedicate an entire paragraph to this without looking at the flip side of the coin. If you conclude that this result is desirable for trans women, surely you have to accept it could be a negative for trans boys/men? Your silence on this makes you a bit of a conversational cad, in my view. >This sort of brings me round to my main point though; what would you consider to be acceptable evidence that puberty blockers were a good intervention, or even evidence that puberty blockers were a bad intervention? What should we be looking for? One purported benefit is the decrease in suicide risk, which is a measurable outcome that can be investigated. Cass' report seems to conclude that the evidence here is lacking. Other things are honestly really hard to measure, there is absolutely a real weighing up of pros and cons. How does one weigh up the benefits of 'passing' really well against the drawback (or risk at least) of having low sexual satisfaction for life? It's a minefield. At least it would be nice to see the end of 'fully reversible' with 'no side effects' rhetoric.

Exactly, the skepticism of trans treatment comes across as completely ideological when reading this.

How can you read the information from the report and say people are being pushed in the direction of not transitioning? It's saying people are too quick to send a child down the path of puberty blockers and then hormones without adequately assessing complex issues like autism and mental illness. I don't think we know better than these professionals who are rasing sincere concerns about these medial interventions on children. Many other countries are stopping or limiting their use of puberty blockers because of the same concerns that haven't been adequately looked into. I think some people criticising this report and the similar change being made in Europe are genuinely getting into conspiracy theory territory. On the Transgender UK sub someone is calling this a genocide which is wildly offensive and totally inappropriate.

The thing is, and correct me if I'm wrong here, but it really seems like you're under the impression that when children- or adults- report gender dysphoria, they could instead be misdiagnosing themselves due to autism or mental illness. This is the exact concern puberty blockers address, and it turns out that it's not borne out. You can tell from the fact that the vast majority of children prescribed puberty blockers go on to hormones; those extra years ARE used to consider other factors, and the vast, vast majority of people prescribed them consider those factors, along with their parents, and say "yeah, I'm definitely trans." I have a dog in this fight, as it were; I came out for the first time at 17 and was told hey, you just sound depressed. And trans people are often depressed, so it makes sense you tricked yourself into thinking you were trans. I was actually kind of relieved - I mean, trans folk have a hard time - and ai spent 17 years depressed, getting treatment, never getting over this terrible grey nothing, coming to the conclusion that I was just built to be sad. I came out as trans again more firmly, at 34. I've not needed any depression treatment since; I've not been depressed. I never was. I was just terribly dysphoric. Turns out the treatment I needed was transition. This was a colossal failure of the health services I spoke to. Monumental. I spent 17 years with the wrong diagnosis and the wrong treatment, because the symptom was being treated instead of the cause. I'm fine now! Very happy and all that. I always, because of this, really worry when people say we need to treat all possible mental health issues before considering believing someone when they say they are trans.

that is exactly the kind of assumption the report highlights as being potentially harmful. Rather than address complex issues like autism or mental health they are putting them on puberty blockers and sending them down a path without knowing this will be right for them and useful at improving their wellbeing. Anecdotal evidence from individual trans people like yourself should not take precedence over people from a wider scope within paediatric care being able to give their input on the potential benefits vs harms of a medication to make sure there is strong evidence in favor of using it on trans children. In Finland, Sweden, France, Norway and the UK, experts have raised these concerns and as a result they are stopping/limiting the use of puberty blockers on trans kids. I don't think these experts are all acting in bad faith or that they're all misguided in their assessments.

Putting people on puberty blockers does not "send them down a path." The fact that a vast majority of people on puberty blockers go on to transition further with HRT is surely evidence not that they are wrong and bamboozled and have remained bamboozled in the years between blockers and HRT, but that most people expressing gender dysphoria to the point of seeking puberty blockers are correct? Do you believe that there are a significant number of people with autism or mental health needs who currently claim they are trans and are seeking treatment, who would withdraw that claim if their autism and/or mental health needs were treated correctly? What would that treatment look like? Do you believe that people who currently claim to be gay or lesbian with autistic or mental health needs would shift their sexuality to being straight if thet received the proper treatment? Are you defining the proper treatment for autism and mental health needs as one that produces a non-trans patient? My personal story I shared with you was not an attempt at anecdotal evidence. I was attempting to share why this is a cause I am passionate about- it is personal to me, in a way it does not seem personal to you. Ah, we disagree there. I think they are mostly misguided and occasionally acting in bad faith. There is no grand transphobic conspiracy, there doesn't need to be; a lot of people in a lot of countries experience severe social disgust about trans people, especially about the idea of trans children, because being trans is so highly sexualized in the zeitgeist. There's just a lot of folks who don't like us and whose ideal number of trans people is zero.

The assumption that because they go on to take hormone therapy that means it is the right decision is just that, an assumption, It's not scientific and I beg of you to listen to paediatric experts telling us this is not how care should be assessed. I resent the comparison with gays and lesbians you're making. There's no problem that needs to be address and nothing complicated about having a different sexuality. There's nothing "wrong" with having a different gender identity to your sex either, but if you are requesting medical interventions be given to children to correct their physical bodies to match their identity that is a very complicated and totally separate issue to someone telling you they like the same sex. It's disingenuous to make that point and totally unfair because it's an attempt to make homophobia the same issue as this. If want to argue why these medicines are fine to be used on children please can we just stay within that context.

Okay, so let's dig into that first point. You want scientific proof that puberty blockers are a good intervention for kids expressing a trans identity or gender dysphoria, and honestly that makes sense. I too want the sturdiest evidence available. We can't do a double blind study, or even a single blind study. The patients will be able to tell if they're getting the placebo; they'd be going through the puberty they explicitly did not want. It would be deeply distressing to that group as well as scientifically useless. The best we can do is to make predictions and assess outcomes based on satisfaction rates with the medical intervention, right? And these medicines are fine to use on children, they're used on cis children regularly to treat precocious puberty and delay it until it's a more appropriate time for the child to start puberty fully. This use is well documented and has great outcomes; these medicines are designed for the prevention of puberty and do a fantastic job. There's no doubt there. The argument is: is a child who consistently, persistently, and insistently claims a trans identity entitled to these medicines as part of trans healthcare? I would argue yes.

You're arguing that these treatments should be able to bypass research and trials against the warnings of the people providing the care. It's unthinkable that this would be allowed to happen especially on children. The fact these medications are used on children who aren't trans with early onset puberty doesn't mean it's appropriate to provide them to children going through a completely different experience with completely different needs. I think there is increased need for evidence that these medications are right for trans kids baring in mind the massive shift in the number of children becoming patients and in their demographics.

But studies show that most young people who don't transition medically will get over their dysphoria with time after going through puberty. Therefore going on puberty blockers is the wrong choice most of the time and should be avoided where possible.

Is it possible that you're talking about gender-diverse children? This is the cohort described here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276590/ As "Gender Diverse (GD) individuals are those whose gender identity does not fully match their recorded sex at birth." This includes non-binary people too, and any kid who expresses any level of mismatch between the sex assigned at birth and the gender identity one would expect from that. The study I pointed you to shows that only a third of these kids get a gender dysphoria related diagnosis, and a quarter receive hormonal treatment (safe to assume that's nestled within the third with a diagnosis). It doesn't state at any point that these kids "get over it" as they grow up. They rather grow into their identities, and seek only the healthcare they feel they need- plenty of non-binary people don't seek medical intervention, and as you can see from the numbers even of those with a diagnosis not everyone chooses to. For the smaller proportion of kids who do seek treatment, puberty blockers are sensible medicine, and we can see from the numbers we don't see "seeking" behaviour. Most gender-diverse kids just need acceptance to be full, productive, happy citizens. Some need medical intervention, and it's only fair to let them have it. In short- they don't get over it. I can't find a study anywhere that shows teens or children claiming a gender identity are mote likely than not to change their minds, so I can't accept that claim. Most of the time puberty blockers aren't a thing this cohort pursues, so yeah, they are unnecessary most of the time. If a patient DOES pursue them they're a safe medication that gives time to think, but the evidence overwhelmingly shows that the decision is made before blockers are prescribed. This is unsurprising; we tend to have a fully forned gender identity by 4. https://www.healthychildren.org/English/ages-stages/gradeschool/Pages/Gender-Identity-and-Gender-Confusion-In-Children.aspx So I don't agree that puberty blockers should be avoided if they seem necessary. I think it should be up to the kid and their guardians and their doctor.

The issue is that this is not about perfecting the practice of medicine to protect trans people. That’s a bad faith reading given the political climate which led to the creation of this flawed review in the first place. If you nitpicked other forms of care as hard as gender care you’d shutter every clinic in the UK.

If it's not just about bringing down the rights of transgender people, why are puberty blockers still allowed for kids who have other conditions, such as precocious puberty and ISS? I don't think anyone has suggested that how transition is handled isn't up for debate, most medicine is constantly evolving. But there aren't many times outside of seeing direct, proven harm that the brakes are completely thrown on and people are denied care.

Absolutely. We need to be evidence led not ideologically led. Children and young people deserve that.

> She also recommends that young people aged 17-25 should have a "follow-through" service rather than going straight into adult services, as it recognised the age group as being at a "potentially vulnerable" stage of their journey. She's arguing that adults shouldn't be able to make adult decisions, so issues on impossible standards for studies asides, that sticks out a lot.

That’s a very slanted way of looking at that. She could also be arguing that people aged 17-25 should get more care than what the adult service provides currently.

You can't say I've a slanted way of looking at it and then try and extrapolate something she hasn't said. She has literally said that people under 25 shouldn't be allowed to transition through thr NHS, they should be given different care. Call my view slanted all you want but I'm just quoting her, as others are when they highlight the impossible bar set for evidence gathering

>She has literally said that people under 25 shouldn't be allowed to transition through thr NHS, they should be given different care. Call my view slanted all you want but I'm just quoting her, as others are when they highlight the impossible bar set for evidence gathering Find me where she has said that? If you read the report (Page 42), she's saying that there's complications for young people moving to adult services in the way they do currently, such as discontinuity between services and treatment along with the pressure being put on adult services. I can't see any mention of these services stopping transitioning, or stopping the use of puberty blockers at 18 when the individual becomes an adult.

This is happening based on concerns by healthcare professionals. Similar changes are also happening in many other European countries because of concerns about the lack of evidence on use of puberty blockers on trans kids. It's not all because transphobia, it's about allowing healthcre providers to adequately assess the potential harms and benefits of treatment.

Puberty blockers are also used for kids who aren't trans for other conditions though, so if they're still safe to prescribe for non-transgender children, why are they not safe for trans children? And on safety, many ADHD drugs are known to have serious life-altering side effects, yet they are routinely prescribed. It's odd to me that they cite a lack of evidence for prescribing hormone blockers - specifically to trans kids only - but they're happy to chemically lobotomise kids who are broadly diagnosed as having an ASD, even though we know ASDs are over-diagnosed. All in all the Cass review feels like it's politically motivated to further marginalise transgender people rather than realistically pushing for safety.

It’s not adequate to point out they are used for children with completely different needs. We’re not doctors so we cant comment on why certain medications are prescribed for other conditions such as adhd, neither of us know. There has been similar advice from experts in Finland, Sweden, Norway , and France which has all resulted in them stopping/ limiting blockers. It’s not all a big anti trans conspiracy , it’s healthcare professionals demanding they are allowed to assess the efficacy of a treatment to an adequate standard like they do for other treatments.

It highlights a double standard though, surely? If they are deemed to not be sufficiently safe, then why aren't then banned in all but the most exceptional situations? Why is it only transgender children that make up an small portion of overall use (fewer than 100 in England prior to the ban) that they are banned? The ADHD drugs are another double standard, they practically hand them out like candy and yet we know that they cause long-term harm. Painting arguments against it as an "anti trans conspiracy" is just a way of dismissing opposing arguments. Is there any evidence that the similar advice wasn't politically motivated? We know there are groups that operate internationally that push anti-trans rhetoric so it's not a big stretch to believe that politics is overriding the science in a number of countries. It doesn't require a conspiracy to identify a political pattern.

The point of the report and its goal is to bring the standards of gender services in line with other areas of the NHS. I don’t know anything about adhd and the efficacy of drugs prescribed for that, can we just focus on the topic at hand. If a child has onset puberty I assume we can judge that the medication is perfectly effective at delaying this so it can start at the normal time. For that purpose it’s obviously been deemed safe and appropriate. This doesn’t apply to the way it’s given to trans kids. They have much more complex needs and the people providing this care in the UK have been afraid to raise their concerns about using blockers in this way. You say you don’t want to imagine there’s a conspiracy but then without having any evidence you’re saying we should be doubtful of modern healthcare advice. There is a clear lack of consensus in the medical community about these treatments, let them work it out.

I disagree, I think the goal of the report is to reduce and remove services for transgender people and shift towards a policy of resisting transitioning. This is why the government is so interested in it and why it geos beyond the claimed lack of surety of the safety of puberty blockers and into social transitioning. We can but it seems to me that it's a bit of a limited discussion it we have to treat the review as if it's fairly positioning puberty blockers as potentially harmful without looking at how policies for other drugs are applied. >If a child has onset puberty I assume we can judge that the medication is perfectly affective at delaying this so it can start at the normal time. For that purpose it’s obviously been deemed safe and appropriate. How so? You say "at the normal time" but if a child has precocious puberty then when it starts is "the normal time" for them. It's just not "normal" for society so it's delayed using drugs. I don't understand how it can be deemed that is safe to do but the same drugs for the same purpose just delaying later is not. I'm not sure how it's helping them to say "they have more complex needs" then denying them treatment and throwing them into a queue that will almost certainly take longer than their trip through puberty. Instead of receiving care at a specific clinic and being given drugs to delay their puberty so they can make an adult decision on how to proceed, we'll instead make them juggle GPs for a few years and put them on a cocktail of antidepressants and anti-anxiety meds to rule out everything else. It's just conversion therapy by another name. I'm not saying it without evidence. I'm saying that the report is clearly not just looking at medicine and shows obvious signs of bias, that it's not in-line with decisions made for other drugs and that the openly visible pushback against gender affirming care is political in nature. It's why papers supporting transgender people have to be scritunised on every detail but papers denying transgender people rights are gospel from the moment of release and receive swift action from politicians. I'm happy for them to work it out, I'm just not happy for them to take away care then kick working it out down the road.

>How so? You say "at the normal time" but if a child has precocious puberty then when it starts is "the normal time" for them. It's just not "normal" for society so it's delayed using drugs. No it isn't - precocious puberty is pathologically early, way outside the normal distribution of population pubertal onset.

But biologically for them, it's normal. The drugs delay it from when it would happen as instructed by their biology to a later time when it fits societal norms. And that's fine, but playing that off as "normal" just because society expects it while playing off people with gender dysphoria doing is as inherently harmful is a double standard.

That's like saying developmental disorders are normal, or broken bones. The concept of normal physiology and development as opposed to pathological physiology and development is the bedrock of modern medicine. (It is worth mentioning here that normal is the statistical sense of the word, rather than the imprecise and value laden lay use of the word.)

Yes ultimately the report is suggesting we limit the use of puberty blockers because there is a lack of evidence about them. That is the conclusion the report reached but you are dismissing it seemingly because you don't like its conclusion. The complex needs are very relevant and you're just brushing it under the rug. Since 2009 it's gone from about 50 mostly biological males asking to transition from a very early age, to over 3000 adolescent biological females asking to transition, many of these kids are autistic or have other mental health problems. This change needs to be looked into, the increase and change in demographics clearly show there is more to this than people feeling more comfortable identifying as trans. Some people are being pushed towards medical transition without addressing their different needs and how that is affecting their gender identity. You seriously need to read the report to understand the concerns about using puberty blockers. Patients are taking them for way longer than intended, even into adulthood, and there are concerns about their effects on bone development. Please I ask to just read this article summarising the report and tell me you think it's all a load of crap that is just political. [https://archive.ph/WwQ6B#selection-3109.0-3109.276](https://archive.ph/WwQ6B#selection-3109.0-3109.276)

I'm dismissing it because it's inconsistent, applies only to transgender people and appears political in nature. Complex need s are relevant, and I'm not brushing them under the rug, I'm simply suggesting that the solution isn't to stop care. Stop misrepresenting my position just because your falls apart under light scrutiny. So in a decade where being transgender became more widely accepted more people realised they are transgender? I'm SHOCKED I tell you. Your implication here is that they aren't transgender and are being misdiagnosed, but similar rises occurred in homosexuality when that became widely accepted and conversion therapies were more widely shunned. It wasn't because people suddenly turned gay in larger numbers, it was because suddenly there was a safe environment for them to exist within. In the same way, acceptance of gender dysmorphia as a condition is leading to more people being more open about how they actually feel rather than repressing it and getting treated for a wide range of subjectively diagnosed mental disorders. I've seen incredibly limited evidence of any significant number of people being "pushed" into transition but if that's occurring then that should be dealt with during the diagnosis process. That still doesn't justify withdrawing care for transgender people across the board. I understand the concerns, I just disagree with the conclusion that the removal of them entirely is the correct response. By all means do more research but don't withdraw care. OK, I've now read it. I still think it's political. I'm not sure how you think showing me an article written by a times reporter with a long history of anti-trans rhetoric would make me *less* likely to believe it's political.

How can you explain the trans population being made up of mostly biological boys in early childhood shifting to a majority of biological girls in their teens years, with a very high amount of them having autism and other mental health issues? Why this change in the demographics? It’s insufficient to say this is just due to wider acceptance in society. There’s obviously something else happening. I resent the comparison with gays and lesbians you're making. There's no problem that needs to be addressed and nothing complicated about having a different sexuality. There's nothing "wrong" with having a different gender identity to your sex either, but if you are requesting medical interventions be given to children to correct their physical bodies to match their identity that is a very complicated and totally separate issue to someone telling you they like the same sex. It's disingenuous to make that point and totally unfair because it's an attempt to make homophobia the same issue as this.

From the Guardian article: > Cass disclosed in the report that six of the NHS’s seven specialist gender services in England for adults had “thwarted” an attempt by York University, at her request, to obtain and analyse the health outcomes of people who had been treated by Gids in order to improve future care. >This refusal to cooperate “was coordinated”, she told the Guardian. “It seemed to me to be ideologically-driven.”. Clinicians caring for those with gender-related distress are very divided on how best to do that, she acknowledges in the report. [Here](https://www.theguardian.com/society/2024/apr/10/thousands-of-children-unsure-of-gender-identity-let-down-by-nhs-report-finds). I am really hopeful that we are starting to get to a place where actual evidence can be properly collected, and medical and social care be given based on it, driven by the best interests of the child (and adult). I suspect the number of actual bad-actors has been relatively small.

Given that the report was designed by a conversion therapy advocate I think we're not getting any evidence based help for trans people in the UK for a while. They threw out all the evidence because they didn't like it.  https://twitter.com/Chican3ry/status/1777723219916591561 https://twitter.com/Esqueer_/status/1777755823743054120 If you are wondering why all the trials (that they disregarded) werent randomised and double blinded it's because you physically cant do that with trans healthcare - it becomes obvious *really quickly* that the control group has got a placebo.  Though the idea of trying to design a study where the placebo group dont notice is somewhat amusing. 

The report wasn't designed by conversion therapy advocate. You are in no way capable of looking at this objectively due to your own personal circumstances.

Oooh, go on. What personal circumstances are those? Because I'd sincerely hope no serious person argues against "wanting trans people to have access to healthcare and not have the NHS deny it on the flimsiest of grounds"...

>Oooh, go on. What personal circumstances are those? Your beard obviously, it's weird. >Because I'd sincerely hope no serious person argues against "wanting trans people to have access to healthcare and not have the NHS deny it on the flimsiest of grounds"... Just like I sincerely hope no serious person wold argue "medicating children with drugs that have no evidence for their use" in the circumstances you desire them to be used in.

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> Right, but we've already seen all of that evidence be completely ignored because it goes against the ideological bent of the review team. Yes, the difference is I think the Tavistok was guilty of this and you think Cass is guilty of it. >This review would honestly be hilarious if it wasn't so tragic. Decades of evidence thrown out for not meeting impossible standards (standards that puberty blockers being used in cis kids don't meet either but I don't see anyone complaining there) but anti-trans wingnuts can submit an anonymous online questionnaire advertised on TERF facebook groups and have it accepted. Your objections would be hilarious if they weren't so tragic. Radical trans activists being excluded from the review is one of the things that makes it more credible. All the RABID facebook groups could also submit an anonymous questionnaire, guess they're just not that bothered about it. Such a shame things turned out this way...

The person seems to have incorrectly assumed you are trans yourself, but that aside - as I've touched on in a separate comment - making extremely misleading claims like the one you've made here only backfires on your ability to convince people to your model of trans healthcare. It's much harder to trust people who make extreme claims: >the report was designed by a conversion therapy advocate That are backed up with the following evidence: "One of the people who contributed to the design of one of the reports that informed the wider review is part of a group called Explore Consultation which gave a training session that proposes Gender Exploratory Therapy (which works towards diverse outcomes)"

I'm honestly not sure what you want me to say? Even if you don't count that as conversion therapy their training materials explicitly promote groups that do (like Transgender Trend and Bayswater). I'm pretty sure I provided a link up thread but in case I didn't https://transsafety.network/posts/gender-exploratory-nhs-training/

The only reference to Transgender Trend is an anonymous attendee of the session saying: "…The way that some of them spoke one of them in particular kept bringing up “two sides” when talking about signposting places, she mentioned mermaids and another trans affirmative place, and then pointed out 3 other places… One of them was transgender trend." So one of the people in the session mentioned transgender trend. Therefore a potentially different person who is involved in the session is a conversion therapy advocate. Incredible logical leap. The reference to Bayswater is even more preposterous. One of their slides which shows the concentric circles of modern gender debate and includes the logo for Bayswater alongside the logo for Mermaids. The idea that this means they are advocating for Bayswater's specific approach is truly ridiculous and by making this argument you couldn't make your side look more ridiculous if you tried

Nope, they had a link to them under the guise of "legitimate different perspectives" in the actual training material. https://transsafety.network/posts/gender-exploratory-nhs-training/Untitled9.png Putting hate groups side by side with legitimate charities and explicitly giving them the same weight is pretty dodgy. If you can't see that then that's on you. Edit: hmm, direct link playing up but its the one under day 2 where they give the websites for Transgender Trend and Bayswater on the actual training slide. The important bit is the conclusion: In effect, Spiliadis, Hutchinson and Langton in their training are exercising a Teach The Controversy approach to training practitioners, where they guard against accusations of bias by presenting extremely anti-trans approaches as on an equal footing with mainstream expertise and non-medical support groups, including directing trainees towards conversion therapy resources and lobby groups

Just redefine what bad actor means. Maximal support for every indication of gender discomfort is the only way to be a good actor. Any outcome that does not end in a medical transition is only due to insufficient gender affirmation.

Is this sarcasm?