What's interesting is that this is an example of extremely bad research. What I was suggesting is a nationally-linked study that can objectively ascertain the number of suicides in current, former, and waitlist patients for the clinics and review this over time in a rigorous way. This appears to be simply a review of clinical records, with no particular rigor behind it.
The author even argues that the public claims "do not meet basic standards for statistical evidence", but then goes on to argue that the figures identified "would not reach statistical significance. In the under 18s specifically" without providing a statistical calculation! At an absolute minimum, you'd want to look at an incidence rate, which is basically the average number of suicides per time period (year, two years, etc) divided by the number of patients or patient-years. It's possible that the number has gone dramatically up or down, because 3 before and 3 after tells us nothing about the denominator! For example, if it went from 3/100,000 to 3/1,000 that would be a massive and statistically significant decrease.
Yes, I think that's fair. I posted the link once I saw what it was, before reading it, because I didn't want to perhaps be influenced regarding whether to share it by the conclusions. But I did read it afterwards and it didn't seem much cop at all.
This is disputed too. It looks like they’re not comparing apples and apples. The information this review has used was for those already under the care of the gender identity clinics, the information the Good Law Product has used also includes those on the waiting list.
"it’s not ridiculous to suggest, for example, that a randomized trial of puberty blockers would be a good idea."
But it is a ridiculous idea to suggest that. A) it can't be double blind because of what puberty blockers do, and b) it leads to permanent changes reversible only by surgery that no one should be subjected to.
I would only agree with this if the test was which puberty blockers are the best. And in all honesty, puberty blockers probably aren't needed and instead hrt monotherapy should probably just be started.
Whelp, guess I won't subscribe to the Health Nerd after all. On other issues that I have not extensively researched, some of the headlines on past postings sounded interesting. But I have done a deep dive on so-called trans gender "affirming" "care", and the Health Nord gets it wrong. The Cass Review didn't go far enough in stepping back from pro-trans-activist assumptions to examine objectively the foundational premise that medical treatment is ever helpful for kids and teens who feel somehow wrong in their sexed bodies. But it did prove that the evidence of benefit was so thin as not to justify the damaging, irreversible medical interventions done experimentally on children.
“clinicians directly involved trans health and transgender people themselves - voices that were largely ignored”. Can you eleaborate? I thought they made sure to interview clinical workers and transgender people.
In the governance, oversight, and publication. Certainly, the review interviewed clinical workers and transgender people, but there were no such experts or patients with lived experience in the leadership of the review, or as far as I can tell involved anywhere in the preparation of the scientific and other documentation. Actually quite a huge departure for the NHS, which usually requires patients with lived experience to be part of the oversight for this sort of thing.
Indeed, groups representing transgender people or their families have complained about being excluded from much of the evidence gathering process. And certainly any analysis or review.
The process reflects the prejudiced opinion that trans (and queer people in general) are broken or mentally unfit. Doing ‘what you have to’ to ‘fix’ us is justified by [religion] opinion presented as ‘obviously true’ belief … etc.
Wasn’t that intentional since this field of medicine and psychiatry is known to be heavily influenced by activists and political interests? Cass herself was chosen because she had no history in the field.
One of the ways AIDS denialists tried to influence healthcare policy was by claiming that researchers with expertise and clinicians providing evidence-based HIV care were all corrupt and biased (and also under the influence of "activists"). They only succeed in one country for a brief time, but that was enough to cause an estimated 330,000 avoidable deaths. I greatly appreciate the efforts to dissect the Cass Review and highlight its flaws, but the context around how it came to be written - and the efforts to now implement it's flawed recommendations - are horrific in a way that too few people seem to appreciate. Transgender healthcare is supposed to serve the needs of transgender people, not be influenced by the fevered delusions of children's authors who live in castles.
What about parents of teenagers who are suddenly saying they are transgender who are suddenly deciding they are transgender, as my teen has? It begs the question to assume that a teen who says they are transgender genuinely is, and brush aside all concerns there may be social influence going on. It was clear cut that someone with AIDS had AIDS.
If your kid is telling you that they are trans, that takes an immense amount of courage. Do yourself and your kid a massive favor and listen to them with an open mind. You're probably anxious about what life holds for them and yes, there are people in the world who will try to make life hard but that does not stop anyone from being trans. The best thing you can do for them is to make sure that they know they are loved as they are and that you will always be there for them.
Navigating the different perspectives of trans-identification in teens is a tough gig - particularly for people who don't find that the concept of a 'gender' in the brain that is separate from your sex all that convincing.
I hope you have found good support for your family
I find the objectivity argument unconvincing. If the NHS has ordered a review into statins headed by anyone but a cardiologist, there would've been a huge outcry. They would also have usually had at least one patient advocate involved at a senior level. Waiving these requirements for gender care doesn't make sense - they could easily have had an oversight committee with this expertise, for example.
I don’t have anything to judge by, since I’ve only seen this one systematic review.
They did commission a systematic review of an area of pediatric medicine headed by a prominent pediatrician. That can be seen as a credible parallel to having a cardiologist head a study in the field of cardiology.
But why? Why is this increase of trans kids happening? Not exponential, as you point out, but for sure an increase a palpable increase. So noticeable that we have written, collectively, how many words about it? You have counted Gideon!
From a biological point of view, assuming (Goodness forbid) these kids are being honest, and this is how they feel (different). They have been born in bodies that biologically do not match their brains.
Could they have been exposed to chemicals/pesticides that mimic sex hormones in utero, thus growing male brains in female bodies?? No. Couldn't be. But if a correlative pattern was detectable, only an epidemiologist could ascertain the estimations of the causations.
It’s still a tiny number of kids - well within normal variations that we see all over the natural world. There have been some studies that suggest it is genetic. But as the author points out, social acceptance and changes in the DSM likely play as factors as well. The issue I see is that we treat this variation as a problem - rather than simply a condition that needs treatment.
An excellent and detailed review of the report. I have one small comment: in part 2 you say that "the people who went to this clinic and responded to the authors when they were asked said that they felt better after transition-related care" and added "there are many possible biases that make it hard to say that the medical and surgical treatments caused the decreases in psychological issues and dysphoria"
With most medical issues this is true: a patiant can say "I took treatment X and condition Y improved", but this is only correlation and it requires more study to determine if the treatment actually *caused* the improvement. But in the case of gender dysphoria (and gender euphoria), people often know what they are feeling and know what caused these feelings: so it is valid just to *ask* them: "Did your transition, supported by your family and friends, resolve your dysphoria, depression and suicidal feelings?" And you can get a valuable result.
> It is now a criminal offense for transgender children to own puberty blockers (it is not an offense for cisgender children).
I may be missing something, and please correct me if so - but is this not a direct violation of the Equality Act 2010? And if it is... it sets a rather worrying precedent that we're apparently not bothering with it any more, no?
To borrow from another topic that's been paid some awareness/attention recently - it's being considered that women experience pain differently to men (and, consequently, our broad understanding of 'typical' presentations of pain and related conditions) and that this means we don't know whether commonly prescribed pain management medications are as suitable or effective for women (not to mention those pregnant or breastfeeding or a number of other things, as they're usually excluded from medical trials).
So imagine if, based on these considerations, it became a criminal offense for a woman to possess prescription pain meds. Or, I guess more broadly, for anyone to possess medications which don't have a sufficient body of research on the individual's specific intersection of demographics. I know I for one am frequently covered by exclusion criteria!
Again, tell me if I'm off with that comparison - it seems beyond absurd that this is the case....
I'm not an expert, but I know the Good Law Project already has a legal case against the ban. I don't know exactly on what grounds they are challenging it, but I know they are doing something. I really hope the ban gets overturned. https://goodlawproject.org/case/challenging-the-ban-on-puberty-blockers/
That review of suicide data you suggested could happen? Looks like it was actually published today! I haven't read the detail yet, but thought you might want to know! https://www.gov.uk/government/publications/review-of-suicides-and-gender-dysphoria-at-the-tavistock-and-portman-nhs-foundation-trust/review-of-suicides-and-gender-dysphoria-at-the-tavistock-and-portman-nhs-foundation-trust-independent-report
What's interesting is that this is an example of extremely bad research. What I was suggesting is a nationally-linked study that can objectively ascertain the number of suicides in current, former, and waitlist patients for the clinics and review this over time in a rigorous way. This appears to be simply a review of clinical records, with no particular rigor behind it.
The author even argues that the public claims "do not meet basic standards for statistical evidence", but then goes on to argue that the figures identified "would not reach statistical significance. In the under 18s specifically" without providing a statistical calculation! At an absolute minimum, you'd want to look at an incidence rate, which is basically the average number of suicides per time period (year, two years, etc) divided by the number of patients or patient-years. It's possible that the number has gone dramatically up or down, because 3 before and 3 after tells us nothing about the denominator! For example, if it went from 3/100,000 to 3/1,000 that would be a massive and statistically significant decrease.
Yes, I think that's fair. I posted the link once I saw what it was, before reading it, because I didn't want to perhaps be influenced regarding whether to share it by the conclusions. But I did read it afterwards and it didn't seem much cop at all.
The author follows a considerable number of "gender critical" accounts https://x.com/ProfLAppleby
This is disputed too. It looks like they’re not comparing apples and apples. The information this review has used was for those already under the care of the gender identity clinics, the information the Good Law Product has used also includes those on the waiting list.
Thank you fine all your work here. Really good.
Minor thing - don’t forget to add the link to the conclusion to the intro of each post where you list all the sections.
Great recap. Thank you for your careful work.
"it’s not ridiculous to suggest, for example, that a randomized trial of puberty blockers would be a good idea."
But it is a ridiculous idea to suggest that. A) it can't be double blind because of what puberty blockers do, and b) it leads to permanent changes reversible only by surgery that no one should be subjected to.
I would only agree with this if the test was which puberty blockers are the best. And in all honesty, puberty blockers probably aren't needed and instead hrt monotherapy should probably just be started.
Whelp, guess I won't subscribe to the Health Nerd after all. On other issues that I have not extensively researched, some of the headlines on past postings sounded interesting. But I have done a deep dive on so-called trans gender "affirming" "care", and the Health Nord gets it wrong. The Cass Review didn't go far enough in stepping back from pro-trans-activist assumptions to examine objectively the foundational premise that medical treatment is ever helpful for kids and teens who feel somehow wrong in their sexed bodies. But it did prove that the evidence of benefit was so thin as not to justify the damaging, irreversible medical interventions done experimentally on children.
So your plan is do what with these kids?
“clinicians directly involved trans health and transgender people themselves - voices that were largely ignored”. Can you eleaborate? I thought they made sure to interview clinical workers and transgender people.
In the governance, oversight, and publication. Certainly, the review interviewed clinical workers and transgender people, but there were no such experts or patients with lived experience in the leadership of the review, or as far as I can tell involved anywhere in the preparation of the scientific and other documentation. Actually quite a huge departure for the NHS, which usually requires patients with lived experience to be part of the oversight for this sort of thing.
Indeed, groups representing transgender people or their families have complained about being excluded from much of the evidence gathering process. And certainly any analysis or review.
The process reflects the prejudiced opinion that trans (and queer people in general) are broken or mentally unfit. Doing ‘what you have to’ to ‘fix’ us is justified by [religion] opinion presented as ‘obviously true’ belief … etc.
Wasn’t that intentional since this field of medicine and psychiatry is known to be heavily influenced by activists and political interests? Cass herself was chosen because she had no history in the field.
One of the ways AIDS denialists tried to influence healthcare policy was by claiming that researchers with expertise and clinicians providing evidence-based HIV care were all corrupt and biased (and also under the influence of "activists"). They only succeed in one country for a brief time, but that was enough to cause an estimated 330,000 avoidable deaths. I greatly appreciate the efforts to dissect the Cass Review and highlight its flaws, but the context around how it came to be written - and the efforts to now implement it's flawed recommendations - are horrific in a way that too few people seem to appreciate. Transgender healthcare is supposed to serve the needs of transgender people, not be influenced by the fevered delusions of children's authors who live in castles.
What about parents of teenagers who are suddenly saying they are transgender who are suddenly deciding they are transgender, as my teen has? It begs the question to assume that a teen who says they are transgender genuinely is, and brush aside all concerns there may be social influence going on. It was clear cut that someone with AIDS had AIDS.
If your kid is telling you that they are trans, that takes an immense amount of courage. Do yourself and your kid a massive favor and listen to them with an open mind. You're probably anxious about what life holds for them and yes, there are people in the world who will try to make life hard but that does not stop anyone from being trans. The best thing you can do for them is to make sure that they know they are loved as they are and that you will always be there for them.
I agree with everything you said. I have a good relationship with open communication going.
Navigating the different perspectives of trans-identification in teens is a tough gig - particularly for people who don't find that the concept of a 'gender' in the brain that is separate from your sex all that convincing.
I hope you have found good support for your family
In other words, there was a concern about objectivity.
I find the objectivity argument unconvincing. If the NHS has ordered a review into statins headed by anyone but a cardiologist, there would've been a huge outcry. They would also have usually had at least one patient advocate involved at a senior level. Waiving these requirements for gender care doesn't make sense - they could easily have had an oversight committee with this expertise, for example.
I don’t have anything to judge by, since I’ve only seen this one systematic review.
They did commission a systematic review of an area of pediatric medicine headed by a prominent pediatrician. That can be seen as a credible parallel to having a cardiologist head a study in the field of cardiology.
But why? Why is this increase of trans kids happening? Not exponential, as you point out, but for sure an increase a palpable increase. So noticeable that we have written, collectively, how many words about it? You have counted Gideon!
From a biological point of view, assuming (Goodness forbid) these kids are being honest, and this is how they feel (different). They have been born in bodies that biologically do not match their brains.
Could they have been exposed to chemicals/pesticides that mimic sex hormones in utero, thus growing male brains in female bodies?? No. Couldn't be. But if a correlative pattern was detectable, only an epidemiologist could ascertain the estimations of the causations.
It’s still a tiny number of kids - well within normal variations that we see all over the natural world. There have been some studies that suggest it is genetic. But as the author points out, social acceptance and changes in the DSM likely play as factors as well. The issue I see is that we treat this variation as a problem - rather than simply a condition that needs treatment.
An excellent and detailed review of the report. I have one small comment: in part 2 you say that "the people who went to this clinic and responded to the authors when they were asked said that they felt better after transition-related care" and added "there are many possible biases that make it hard to say that the medical and surgical treatments caused the decreases in psychological issues and dysphoria"
With most medical issues this is true: a patiant can say "I took treatment X and condition Y improved", but this is only correlation and it requires more study to determine if the treatment actually *caused* the improvement. But in the case of gender dysphoria (and gender euphoria), people often know what they are feeling and know what caused these feelings: so it is valid just to *ask* them: "Did your transition, supported by your family and friends, resolve your dysphoria, depression and suicidal feelings?" And you can get a valuable result.
> It is now a criminal offense for transgender children to own puberty blockers (it is not an offense for cisgender children).
I may be missing something, and please correct me if so - but is this not a direct violation of the Equality Act 2010? And if it is... it sets a rather worrying precedent that we're apparently not bothering with it any more, no?
To borrow from another topic that's been paid some awareness/attention recently - it's being considered that women experience pain differently to men (and, consequently, our broad understanding of 'typical' presentations of pain and related conditions) and that this means we don't know whether commonly prescribed pain management medications are as suitable or effective for women (not to mention those pregnant or breastfeeding or a number of other things, as they're usually excluded from medical trials).
So imagine if, based on these considerations, it became a criminal offense for a woman to possess prescription pain meds. Or, I guess more broadly, for anyone to possess medications which don't have a sufficient body of research on the individual's specific intersection of demographics. I know I for one am frequently covered by exclusion criteria!
Again, tell me if I'm off with that comparison - it seems beyond absurd that this is the case....
Unfortunately I do not know enough about UK law to comment.
I'm not an expert, but I know the Good Law Project already has a legal case against the ban. I don't know exactly on what grounds they are challenging it, but I know they are doing something. I really hope the ban gets overturned. https://goodlawproject.org/case/challenging-the-ban-on-puberty-blockers/