[amanaplanacanal]

It's clear that earlier intervention with gender affirming care leads to better outcomes. There are fewer suicides when people start getting care earlier. This means puberty blockers early, and HRT in late teenage years. Are we just ignoring that?

[Manuel_D]

The Cass review, most notably, pointed out that the research supporting these claims are extremely weak. In particular there have only been two randomized controlled trials studying blockers in minors, and neither of them saw improvements over the control group. To date, the UK, Finland, Sweden, Italy. Norway, and Denmark have stopped prescribing puberty blockers to minors with gender dysphoria.

[viamiraia]

The Cass review has been widely rejected by reputable medical associations. In addition, reviews of the Cass review have found several flaws and instances of bias: https://bmcmedresmethodol.biomedcentral.com/articles/10.1186...

Don't get me wrong, trans issues do need more study, but this is also an example of isolated demand for rigor. Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?

In addition, trans healthcare in Sweden has historically been behind the US. Trans people were forcibly sterilized up until 2013, and trans healthcare underfunded. In Finland the sterilization was required until 2023!

[Manuel_D]

The Cass review was not, in fact, rejected by most reputable medical institutions. Unless, if course, your criteria for "reputable medical institution" includes support for puberty blockers and hormones treatment in minors.

The UK, Italy, Denmark, and Sweden all stopped prescribing puberty blockers to gender dysphoric children following the Cass review. Other countries, like Finland, has stopped earlier. It's not possible to continue insisting that this is settled science, when much of the developed world has broken with the US's approach towards gender care in minors.

> Why the undue focus and criticism of trans healthcare over treatment of other rare medical conditions, which also tend to lack RCTs?

Such as? Furthermore, there were RCTs conducted studying the effects of puberty blockers. They didn't decrease gender dysphoria.

Also, put the evidence (or lack thereof) in the context of the certainty and urgency that proponents of gender medicalization were conveying: People were claiming that gender dysphoric children were going to kill themselves if they don't get blockers. Doctors like Joanna Olson-Kennedy repeatedly claimed that parents had the choice of a dead son or alive daughter, a statement parroted by politicians.

This was all total BS. That very same doctor sat on data showing zero improvement with puberty blockers [1]. And now she's trying to argue that no benefit is actually a good result because the patients would have fared even worse absent blockers. But of course, without a control group there's no substance to that claim.

1. https://www.nytimes.com/2024/10/23/science/puberty-blockers-...

[a_shovel]

> This was all total BS. That very same doctor sat on data showing zero improvement with puberty blockers

> "“They’re in really good shape when they come in, and they’re in really good shape after two years,”"

So a treatment that causes a change to not happen does not cause those who are doing well to do even better? Is this the evidence that's supposed to make me want to ban a widely-accepted medical treatment?

[Manuel_D]

Correct. A treatment that causes no change in well-being, and has negative side effects on bone density, mental development, and more, is not a net positive treatment. This isn't even touching on the effect puberty blockers have on persistence rates. The justification for puberty blockers is that they lead to better outcomes, and the research doesn't show that.

Even stronger evidence for stopping the prescription of blockers are the randomized control trials conducted in Finland and the UK. The patients who received blockers fared no better that those that did not. Without a control group, there's no way to prove or disprove Olson-Kennedy's claim that the patient would have fared worse absent blockers. But the few studies on blockers that did have a control group found no improvement over the control.

And you're wrong that these treatments are widely accepted. In about half of the US they're already banned. In Europe, the UK, Finland, Sweden, Italy, Norway, and Denmark have all stopped prescribing puberty blockers. It is no longer correct to call this treatment widely accepted.

[a_shovel]

"Gender-Affirming Medical Treatments for Pediatric Patients with Gender Dysphoria", College of Pharmacy University of Utah, https://le.utah.gov/AgencyRP/reportingDetail.jsp?rid=636 , states:

> Page 116: "... the consensus of the evidence supports that the treatments are effective in terms of mental health, psychosocial outcomes, and the induction of body changes consistent with the affirmed gender in pediatric GD patients. The evidence also supports that the treatments are safe in terms of changes to bone density, cardiovascular risk factors, metabolic changes, and cancer."

If you could cite these randomized controlled trials, that would be great.

In how many US states were pediatric gender treatments suspended or phased out by medical bodies because doctors examined the evidence and determined that the treatments were not beneficial? That's what I would expect if the treatments really didn't work. From what I know, this isn't the case for any of the bans. The bans are all laws passed by state legislatures, especially conservative ones, and aren't meaningful evidence of anything except conservative lawmakers' political incentives.

[Redoubts]

There’s no evidence for any of those statements

[ghushn3]

Here's a study that shows evidence that puberty blockers reduce lifelong suicidal ideation: https://pmc.ncbi.nlm.nih.gov/articles/PMC7073269/

Here's a study showing evidence that gender dysphoria treatment in children improves well-being and mental health: https://pubmed.ncbi.nlm.nih.gov/25201798/

There's loads more.

[ghostpepper]

If I'm reading that first study correctly, "Ideation" and "Ideation with plan" are lower but "Ideation with plan and attempt" is higher and "Attempt resulting in inpatient care" is almost twice as high.

Neither the discussion nor the conclusion mention this, so maybe I'm misinterpreting something?

[viamiraia]

The results for attempts are underpowered and they acknowledge this (note the p-values too), but not for ideation. From the discussion:

> We did not detect a difference in the odds of lifetime or past-year suicide attempts or attempts resulting in hospitalization. It is possible that we were underpowered to detect these differences given that suicide attempt items were less frequently endorsed than suicidal ideation items (Table 3). Given this study’s retrospective self-report survey design, we were unable to capture information regarding completed suicides, which may have also reduced the number of suicide attempts we were able to account for. Given that suicidal ideation alone is a known predictor of future suicide attempts and deaths from suicide, the current results warrant particular concern.

[michtzik]

The study also doesn't include the successful suicides.