[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.

[Manuel_D]

You didn't link to a randomized controlled trial. You linked to a meta review. This is just reading and summarizing past research publications, not a RCT.

To date, no American study has been conducted that randomly assigned patients into groups put on blockers or not. That's the best way to study the effects of blockers: Have psychiatrists identify a group of 100 people that they think should be put on blockers. Flip a coin to assign 50 of those patients into a control group that doesn't receive blocker and the other 50 do. And then monitor their lifetime outcomes.

This is how the Finnish 2019 study functioned, and they found no improvement over the control group (and the country stopped providing blockers a year later). American gender medicine researches argue that it's unethical to conduct an RCT and deprive have the patient sample access to life-saving care. But of course, they don't know that this care is beneficial - let alone "life-saving" - until they actually compare the outcomes against a control group.

It's unfortunate that the rollbacks in America had to come from politicians instead of an internal process from the medical establishment. But ultimately, North American gender medicine has thus far refused to conduct effective research into the efficacy of medicalized youth gender care like their European colleagues. Politicians, and the public, have recognized this.

If proponents of medicalized youth gender care want to try and justify that this treatment is necessary, they ought to actually do randomized controlled trials. If we have cohorts of children expressing the same levels of discomfort with their gender, and the randomly-assigned treatment group sees better outcomes than the control group, that is a much stronger piece of evidence than only having a treatment group and baselessly claiming that the control group would have fared worse.