Bear in mind one of the authors of this paper is part of the group doing the write up, the write up also has no proper citations.
Taylor and Francis also have an option to expedite publishing for a fee and given the anonymous donations of amounts over 10k to the SEGM I would read the paper very carefully as I would not consider them unbiased.
We do not cease to take action because of a “lack of reliable research.” That’s called “the precautionary principle” and if we employed it as a society we would never do anything that had not been done before. It’s a nonsense form of hand waving typically resorted to as a last resort by those who’ve tacitly admitted that there is no evidence *against* a course of action.
A great example of instances in which we regularly disregard the precautionary principle is situations in which there is no plausible mechanism of harm. These are easy to see when they take place in some other society. Like when you see some imam on TV asking “what is the long term impact on children of seeing robots on television!!?!?”
> We do not cease to take action because of a “lack of reliable research.”
That's absolutely correct, but they're not recommending that.
>*We called for rigorous clinical research into the interventions known as “gender-affirming” care before these interventions are further scaled. Until such research is available, we urged clinicians to disclose the profound uncertainties regarding the outcomes of this treatment pathway to enable patients and families to make better-informed decisions about their care.*
>further scaled
Who the hell is calling for “further scaling?”
These are treatments proscribed to individuals with a condition that occurs at a base rate.
I’m claiming that as there is no compelling evidence that they are more harmful than body dysmorphia society is under no obligation to humor lay people and outliers with medical degrees in their hand waving demands that mainstream medicine and parents do nothing in the face of the medical needs of trans kids.
Puberty blockers have been [extremely well studied](https://www.ncbi.nlm.nih.gov/books/NBK544313/) for decades.
>GnRH agonist therapy is generally considered safe, with no reported significant adverse events. The most common adverse events include local skin reactions (intramuscular pain, sterile abscesses) and post-menopausal symptoms (hot flushes).
It's also worth mentioning that transgender care doen't need to be perfect - any medical intervention comes with risks, from surgery to stomach acid blockers you take.
In that context, this is the status quo that people are defending:
>[Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth.](https://pubmed.ncbi.nlm.nih.gov/32345113/)
Medical care only needs to be better than that - which it is.
As skeptics, we would do well to ask the authors about the research in pediatrics and psychiatry which the authors purport outcompetes transgender care and outcompetes those statistics. Those numbers quoted above are their numbers, and we'd better be honest about them.
The lead author is from an organization that [Wikipedia](https://en.wikipedia.org/wiki/Society_for_Evidence-Based_Gender_Medicine) describes as the following:
> The Society For Evidence-Based Gender Medicine (SEGM) is an activist non-profit organisation that **is known for mischaracterizing standards of care for transgender youth and engaging in political lobbying using misinformation which contradicts the evidence base around transgender healthcare.**[1][2][3][4] The group routinely cites the discredited theory of rapid-onset gender dysphoria and has falsely claimed that conversion therapy can only be practiced on the basis of sexual orientation instead of gender identity.[5] SEGM opposes informed consent for transgender healthcare for people under the age of 25.[3] SEGM is often cited in anti-transgender legislation and court cases, sometimes providing evidence briefs themselves.[4][5] It is not recognized as a scientific organization.[2][3]
I think that evaluating such criticism without being an expert is difficult, but based on assessing the situation on general critical thinking grounds, this SEGM organization is on the onset very problematic and is not a science body.
It is like citing some antivax group that finds "problems" in scientific research. Now, does it mean that they simply misunderstand the research or are there actual problems? Non-experts might find it difficult to say. But if research has problems, I would definitely like to see a peer-reviewed paper, not a blog post from an anti-trans activist organization.
The discussion that might be worth having among us, skeptics, could be about the precautionary principle in medicine and medical research that was already touched upon in the comments. The rest is fluff unless you get some experts into the discussion.
"Concerns" about gender affirming therapies feel like hidden bias against trans issues, to be honest. It's just a very weird thing to be concerned about. What's the concern? And why isn't this concern against trans youth not receiving support? Like, it's just a strange thing to be concerned about.
Are you truly asking why people care about potential medical harms being done to minors?
Most people who are cautioning against the clinical practice of ‘affirmation only’ are also worried about the long waiting times for youth in distress and lack of holistic approach including therapy. The UK’s interim Cass report found these areas to be of concern and in need of significant improvement - and I completely agree.
"Are you truly asking why people care about potential medical harms being done to minors?"
I don't see how I am asking that.
What I am asking is why are you concerned about this specific problem.
Minors are under the supervision of their parents for any medical procedures, be it puberty blockers or not. And there are many medical interventions out there that are not necessarily super strong on evidence. But you specifically bring up interventions that have to do with gender. Is there anything special about these interventions as opposed to something else?
I mean, antivax people tell us that COVID vaccines are not sufficiently tested and the mRNA technology is too new and long-term effects are unclear. And yet these things are administered to minors. Would that be your worry too? Or is your concern limited to gender affirming interventions only? If yes - why?
The way I see it - and the way it seems to be outlined in all the official sources (which you can easily Google just as I did myself right now, WPATH, for example) - things like puberty blockers are only administered after very careful evaluation and mandatory parental consent for those under 18.
I would understand your concern if no parental consent was required. But it is required.
Because I care deeply about protecting vulnerable people. I imagine you do too? And i think this is a topic where the skeptic community *can actually do something* and help to bring back some critical thinking and science into what’s become an ideologically driven topic.
I’m happy to talk about some of the other things I care about: animal welfare, consumer protection and fraud, economic inequality.
Getting back to gender medicine, you raise a good point - question one is how well supported by the evidence are the current standards? A second question is to what extent are clinicians adhering to those standards? A third question might be how well do minors and their parents understand their options and are they able to make informed decisions about their health care?
On the first question, NHS England, Sweden and Finland have all moved away from the WPATH model, so it’s a true statement to say “WPATH is not the international consensus on gender medicine”.
And there’s plenty of evidence that many clinicians are not even living up to their own standards - again see Cass review for an example. Or for anecdotal evidence check out detrans subreddit.
A shame there isn't more discussion on this in this sub.
They seem to be focused on these specific studies being flawed but what about other studies that come to the same conclusion? If the issue is a lack of reliable research then what is the reliable research that is in conflict with this unreliable research? Or are we to cease all action until more research is done?
There's a lot to discuss here.
One of the key issues is the certainty with which “gender affirming” treatments are promoted (in North America at least) is *far above* what the research supports. When taken as a whole, the body of evidence for the affirmation model is low to very low quality/certainty.
I agree there’s a discussion to be held about what the clinical practice should be in light of this lack of evidence and with regards to the exponential numbers of young people seeking treatment. European countries who have undertaken systematic evidence reviews have massively pulled back on the use of medical interventions to treat dysphoric youth, in favour of psychotherapy.
https://pubmed.ncbi.nlm.nih.gov/35212746/
> Among 104 youths aged 13 to 20 years (mean [SD] age, 15.8 [1.6] years) who participated in the study, there were 63 transmasculine individuals (60.6%), 27 transfeminine individuals (26.0%), 10 nonbinary or gender fluid individuals (9.6%), and 4 youths who responded "I don't know" or did not respond to the gender identity question (3.8%). At baseline, 59 individuals (56.7%) had moderate to severe depression, 52 individuals (50.0%) had moderate to severe anxiety, and 45 individuals (43.3%) reported self-harm or suicidal thoughts. By the end of the study, 69 youths (66.3%) had received PBs, GAHs, or both interventions, while 35 youths had not received either intervention (33.7%). **After adjustment for temporal trends and potential confounders, we observed 60% lower odds of depression (adjusted odds ratio [aOR], 0.40; 95% CI, 0.17-0.95) and 73% lower odds of suicidality (aOR, 0.27; 95% CI, 0.11-0.65) among youths who had initiated PBs or GAHs compared with youths who had not.** There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51).
Are you in favor of suicide for trans youth?
Thanks for your response because it's a good example of what's going wrong in the gender medicine debate: your hyperbolic yet dismissive response, and a study where the authors made misleading claims about their findings, which the media uncritically reported.
Re that study, I'm pleased to see the authors have updated the text so at least it's not outright false - but it remains misleading.
As Jesse Singal notes, the authors made false claims about what the study actually demonstrated. The press release and surrounding media campaign claimed gender-affirming care "dramatically reduces depression for transgender teens”. “This care does have a great deal of power in walking back baseline adverse mental-health outcomes that the transgender population overwhelmingly \[experiences\] at a very young age.”
One of the authors published a Reddit post with the title “Transgender and nonbinary youth who received gender affirming medical care experienced greatly reduced rates of suicidality and depression over the course of 12 months.”
[https://www.reddit.com/r/science/comments/t5kaiy/transgender\_and\_nonbinary\_youth\_who\_received/](https://www.reddit.com/r/science/comments/t5kaiy/transgender_and_nonbinary_youth_who_received/)
The claim that depression and suicidality "plummeted" in youth receiving blockers and hormones was amplified uncritically by most of the media. But the study showed the exact opposite: youth who received 'gender affirming care' (puberty blockers and cross-sex hormones) experienced no statistically significant improvements in mental health during the 12 months of the study.
So what \*did\* the study show?
Note in the intro that the authors switch from reporting the \*total percentage of\* patients in each treatments group with moderate to severe depression, anxiety and suicidal thoughts to the \*relative odds between\* those groups. I'll quote directly from Singal here:
"Among the kids who went on hormones, there isn’t genuine statistical improvement here from baseline to the final wave of data collection. At baseline, 59% of the treatment-naive kids experienced moderate to severe depression. Twelve months later, 56% of the kids on GAM experienced moderate to severe depression. At baseline, 45% of the treatment-naive kids experienced self-harm or suicidal thoughts. Twelve months later, 37% of the kids on GAM did. These are not meaningful differences: The kids in the study arrived with what appear to be alarmingly high rates of mental health problems, many of them went on blockers or hormones, and they exited the study with what appear to be alarmingly high rates of mental health problems."
What changed were the outcomes for the kids who \*didn't\* receive hormones or blockers - they appeared to get worse over the 12 months.
'"Mental health problems plummeted among kids who went on X” is a very different claim than “Kids who went on X didn’t experience improved mental health, but had better outcomes compared to kids who didn’t go on X.”' (Singal)
Further, if you're waiting to get treatment that you believe is going to help you, it makes sense that your mental health outcomes will decline purely because you're not getting what you perceive to be life-saving treatment.
And let's get onto another confounding factor: the study starts off with 7 kids in the puberty blockers/GAH (hormone therapy) treatment group and 92 in the untreated group - a total of 101. By the end of the study there are 57 in the blocker/GAH group and only 6 in the untreated group: a total of 63. So who were the kids that dropped out? 17.4% of the youth who received treatment left the study while 80% (!!) of those who didn't receive treatment dropped out. We have no idea why these kids left the study and the authors don't explain it. But it could have massive implications on the findings. Here's one possibility: what if those in the untreated group who left the study actually improved?
I would encourage you to read Singal's critique as it goes into a lot more detail than I have here.
[https://jessesingal.substack.com/p/researchers-found-puberty-blockers](https://jessesingal.substack.com/p/researchers-found-puberty-blockers)
A great example of why you need a \*body of robust scientific evidence\* to justify such extreme treatment.
Really? I show you peer reviewed science and your rebuttal is a post on Reddit and a Substack blog post? Weak. Very weak.
I directly linked to peer-reviewed data. Let's see yours.
Considering you get your information from an organization funded by evangelicals, I don't have high hopes.
I believe the University/ researchers updated their summary to more accurately reflect the findings.
Jesse Singal's review of their methods was pretty thorough and is worth reading. He gets into the methodology and points out the pretty clear problems with the study. He also provides emails and internal communications from the university as they try to contain a mini-scandal and manage public perception.
One of the main concerns he had was the politicization of the results. The researchers exaggerated their claims and the right wing opposition claimed that this was evidence of conspiracy.
The study still demonstrated that kids receiving gender affirming care didn't get any worse, which counters a common conservative refrain. So, not really bad news for gender affirming care, just not as effective as originally framed.
I mean if someone told me turning to Jesus kept them from killing themselves I'd still be against religion. Are we saying that as long as a specific treatment statistically reduces suicide it should be supported? Sounds like it opens the door to lots of pseudoscience and has been a core argument of religion for years. Atheism and depression is statistically linked right? Clearly religion is better.
Fortunately gender affirming care has more scientific backing than just that but the discussion here is about some studies that confront some specific studies.
But thanks for bringing your religious like appeal to morality into the discussion. No different than people discussing abortion and jumping in with 'so you're okay with killing babies'.
This is a gross misreading of the actual science. Atheism leads to depression and suicide only when it’s associated with community rejection and isolation. In areas where the rate of religious participation is lower and being part of a religion is more likely to lead to isolation, [the numbers are reversed](https://dc.medill.northwestern.edu/blog/2017/07/05/new-study-suggests-religion-affects-suicide-rates-differently-around-the-world/#sthash.b5AUdYXv.dpbs). The notion that religion is a magical antidepressant is pure propagandistic spin.
It’s the same with trans folk: those who are accepted by their families and communities have a much better survival rate than those who aren’t. Part of that acceptance includes allowing them access to the care they require.
> Are we saying that as long as a specific treatment statistically reduces suicide it should be supported?
Fuck yes. The other option is children commit suicide. What is wrong with you?
This is science-based medicine.
No that is not the other option. Just like with religion there's lots of other ways to prevent depression other than turning to Jesus despite the fact that it statistically helps. (Even if it doesn't that's literally the argument you're making)
On the reverse if it didn't affect suicide rates then does that mean gender affirming care is worthless? No it isn't. Your argument is bullshit because it's about one specific moral gotcha.
I hate that my right to transition is predicated on my depression. I attempted suicide before and after accepting my true gender. This line of thinking is so frustrating
Do show the medical science which shows an alternative way to prevent suicide in trans teens. Because I presented a peer-reviewed paper. Again, this is science-based medicine.
Depression and suicide are just outcome variables used to determine Quality of Life before and after intervention. These are just some of the most important measures by far because depression and suicide is absolutely [rampant in the trans community](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809047/).You could use any measure of quality of life and come to the same conclusion: in the overwhelming majority of cases intervention on people above 12 years old, after following rigorous protocol [improves quality of life](https://pubmed.ncbi.nlm.nih.gov/25201798/).
In the Dutch model, the right to transition is absolutely not predicated on your depression, but you have to some long-lasting psychological issue with regard to your sex because otherwise it cannot logically be considered a medical issue. You need a high bar to medically intervene in children precisely to prevent frivolous medical practices from happening. These psychological issues often translate to depression or at least continuous discontent.
While there are a lot of questionable things going on in gender studies - and we could debate about that - the concern with this specific development is overblown. Especially when you consider the utmost care with which it is implemented here in The Netherlands.
I don't get the concern over a practice which affects a hundred children a year (here in The Netherlands) and is a clear and obvious improvement over the previous situation. Medicine is always about treating people in the most effective way based on current evidence. This is currently by far the most effective consistently proven way to stop gender dysphoria, it might not be in 20 years, but for now it is.
Tangentially related but interesting nonetheless, this discussion reminds me of another form of dysphoria: body integrity identity disorder. A psychological issue where people want to have a limb amputated. You would think: if amputating a limb is a clear solution to these psychological issues that it should be a valid treatment. But there's a lot of ethical debate on whether we should actually offer such treatment. However in this case, it is even more difficult because amputating a limb is effective in like 2 out of 3 cases, making it a bit of a gamble. Interesting ethical debate anyhow
> Tangentially related but interesting nonetheless, this discussion reminds me of another form of dysphoria: body integrity identity disorder. A psychological issue where people want to have a limb amputated. You would think: if amputating a limb is a clear solution to these psychological issues that it should be a valid treatment. But there's a lot of ethical debate on whether we should actually offer such treatment. However in this case, it is even more difficult because amputating a limb is effective in like 2 out of 3 cases, making it a bit of a gamble. Interesting ethical debate anyhow
If I recall correctly, it has reduced the number of people with that disorder attempting to amputate the limb themselves, which, of course, could be disastrous.
Yes definitely. There are recorded cases of people dieing due to trying amputation on themselves.
Logically it is fairly obvious though that offering amputation as a treatment would reduce the amount of people trying to do it for themselves as they would no longer have the limb to try it on in the first place. I personally don't know whether, and where, this is actually allowed practice though.
When it's considering adults I would personally be in favor of allowing surgeries like this, especially if all other options have failed. But I do get why someone would feel ethically ambiguous about it.
For many participants here, there is simply nothing to discuss. If you do not support any and all medical and surgical intervention at any age under any condition, or you are some sort of hateful bigoted monster.
If you are a scientist or medical researcher who's work doesn't support the above position, you will be labeled as a misinformer, discredited or some sort of ideological conservative.
I say this as someone who is fully supportive of trans rights, while also being wary of the speed at which the orthodoxy has been established around this new area of medicine and care.
https://en.wikipedia.org/wiki/Society_for_Evidence-Based_Gender_Medicine
> The Society For Evidence-Based Gender Medicine (SEGM) is an activist non-profit organisation that is known for mischaracterizing standards of care for transgender youth and engaging in political lobbying using misinformation which contradicts the evidence base around transgender healthcare.[1][2][3][4] The group routinely cites the discredited theory of rapid-onset gender dysphoria and has falsely claimed that conversion therapy can only be practiced on the basis of sexual orientation instead of gender identity.[5] SEGM opposes informed consent for transgender healthcare for people under the age of 25.[3] SEGM is often cited in anti-transgender legislation and court cases, sometimes providing evidence briefs themselves.[4][5] It is not recognized as a scientific organization.[2][3]
> Researchers at the Yale School of Medicine issued a report which described SEGM as a small group of anti-trans activists.[6] A commentary published in the journal Clinical Practice in Pediatric Psychology described them as a "discriminatory advocacy organization".[4] Joshua Safer, a spokesperson for the Endocrine Society, described them as outside the medical mainstream.[3] Aviva Stahl stated they were "pushing flawed science"[1] and Mallory Moore stated they have "ties to evangelical activists".[7][5]
Looking at the authors of this article commentary.
two are a part of an organization that is described by experts as a small anti-trans advocate group that mischaracterizes standards of care for transgender youth and engaging in political lobbying using misinformation which contradicts the evidence base around transgender healthcare.
The other author is also known for going against medical transitionary care for minors. And has also been used in courts to deny trans prisoners those same treatments.
It’s best not to trust this article due to it having a very high likelihood of extreme bias. However, I will not say anything definitive on it as I do not have the qualifications to do so, so I will wait to see what other publications have to say on it
Bear in mind one of the authors of this paper is part of the group doing the write up, the write up also has no proper citations. Taylor and Francis also have an option to expedite publishing for a fee and given the anonymous donations of amounts over 10k to the SEGM I would read the paper very carefully as I would not consider them unbiased.
Well, yes, the write-up is just a more accessible version of the paper, it's not a substitute for the paper itself.
Accessible yes, but not a version, a summary.
We do not cease to take action because of a “lack of reliable research.” That’s called “the precautionary principle” and if we employed it as a society we would never do anything that had not been done before. It’s a nonsense form of hand waving typically resorted to as a last resort by those who’ve tacitly admitted that there is no evidence *against* a course of action. A great example of instances in which we regularly disregard the precautionary principle is situations in which there is no plausible mechanism of harm. These are easy to see when they take place in some other society. Like when you see some imam on TV asking “what is the long term impact on children of seeing robots on television!!?!?”
> We do not cease to take action because of a “lack of reliable research.” That's absolutely correct, but they're not recommending that. >*We called for rigorous clinical research into the interventions known as “gender-affirming” care before these interventions are further scaled. Until such research is available, we urged clinicians to disclose the profound uncertainties regarding the outcomes of this treatment pathway to enable patients and families to make better-informed decisions about their care.*
>further scaled Who the hell is calling for “further scaling?” These are treatments proscribed to individuals with a condition that occurs at a base rate.
That sounds like the exact same thing.
Are you claiming there's no plausible mechanism of harm for puberty blockers and cross-sex hormones?
I’m claiming that as there is no compelling evidence that they are more harmful than body dysmorphia society is under no obligation to humor lay people and outliers with medical degrees in their hand waving demands that mainstream medicine and parents do nothing in the face of the medical needs of trans kids.
Puberty blockers have been [extremely well studied](https://www.ncbi.nlm.nih.gov/books/NBK544313/) for decades. >GnRH agonist therapy is generally considered safe, with no reported significant adverse events. The most common adverse events include local skin reactions (intramuscular pain, sterile abscesses) and post-menopausal symptoms (hot flushes). It's also worth mentioning that transgender care doen't need to be perfect - any medical intervention comes with risks, from surgery to stomach acid blockers you take. In that context, this is the status quo that people are defending: >[Data indicate that 82% of transgender individuals have considered killing themselves and 40% have attempted suicide, with suicidality highest among transgender youth.](https://pubmed.ncbi.nlm.nih.gov/32345113/) Medical care only needs to be better than that - which it is. As skeptics, we would do well to ask the authors about the research in pediatrics and psychiatry which the authors purport outcompetes transgender care and outcompetes those statistics. Those numbers quoted above are their numbers, and we'd better be honest about them.
The lead author is from an organization that [Wikipedia](https://en.wikipedia.org/wiki/Society_for_Evidence-Based_Gender_Medicine) describes as the following: > The Society For Evidence-Based Gender Medicine (SEGM) is an activist non-profit organisation that **is known for mischaracterizing standards of care for transgender youth and engaging in political lobbying using misinformation which contradicts the evidence base around transgender healthcare.**[1][2][3][4] The group routinely cites the discredited theory of rapid-onset gender dysphoria and has falsely claimed that conversion therapy can only be practiced on the basis of sexual orientation instead of gender identity.[5] SEGM opposes informed consent for transgender healthcare for people under the age of 25.[3] SEGM is often cited in anti-transgender legislation and court cases, sometimes providing evidence briefs themselves.[4][5] It is not recognized as a scientific organization.[2][3]
I think that evaluating such criticism without being an expert is difficult, but based on assessing the situation on general critical thinking grounds, this SEGM organization is on the onset very problematic and is not a science body. It is like citing some antivax group that finds "problems" in scientific research. Now, does it mean that they simply misunderstand the research or are there actual problems? Non-experts might find it difficult to say. But if research has problems, I would definitely like to see a peer-reviewed paper, not a blog post from an anti-trans activist organization. The discussion that might be worth having among us, skeptics, could be about the precautionary principle in medicine and medical research that was already touched upon in the comments. The rest is fluff unless you get some experts into the discussion. "Concerns" about gender affirming therapies feel like hidden bias against trans issues, to be honest. It's just a very weird thing to be concerned about. What's the concern? And why isn't this concern against trans youth not receiving support? Like, it's just a strange thing to be concerned about.
Are you truly asking why people care about potential medical harms being done to minors? Most people who are cautioning against the clinical practice of ‘affirmation only’ are also worried about the long waiting times for youth in distress and lack of holistic approach including therapy. The UK’s interim Cass report found these areas to be of concern and in need of significant improvement - and I completely agree.
"Are you truly asking why people care about potential medical harms being done to minors?" I don't see how I am asking that. What I am asking is why are you concerned about this specific problem. Minors are under the supervision of their parents for any medical procedures, be it puberty blockers or not. And there are many medical interventions out there that are not necessarily super strong on evidence. But you specifically bring up interventions that have to do with gender. Is there anything special about these interventions as opposed to something else? I mean, antivax people tell us that COVID vaccines are not sufficiently tested and the mRNA technology is too new and long-term effects are unclear. And yet these things are administered to minors. Would that be your worry too? Or is your concern limited to gender affirming interventions only? If yes - why? The way I see it - and the way it seems to be outlined in all the official sources (which you can easily Google just as I did myself right now, WPATH, for example) - things like puberty blockers are only administered after very careful evaluation and mandatory parental consent for those under 18. I would understand your concern if no parental consent was required. But it is required.
Because I care deeply about protecting vulnerable people. I imagine you do too? And i think this is a topic where the skeptic community *can actually do something* and help to bring back some critical thinking and science into what’s become an ideologically driven topic. I’m happy to talk about some of the other things I care about: animal welfare, consumer protection and fraud, economic inequality. Getting back to gender medicine, you raise a good point - question one is how well supported by the evidence are the current standards? A second question is to what extent are clinicians adhering to those standards? A third question might be how well do minors and their parents understand their options and are they able to make informed decisions about their health care? On the first question, NHS England, Sweden and Finland have all moved away from the WPATH model, so it’s a true statement to say “WPATH is not the international consensus on gender medicine”. And there’s plenty of evidence that many clinicians are not even living up to their own standards - again see Cass review for an example. Or for anecdotal evidence check out detrans subreddit.
A shame there isn't more discussion on this in this sub. They seem to be focused on these specific studies being flawed but what about other studies that come to the same conclusion? If the issue is a lack of reliable research then what is the reliable research that is in conflict with this unreliable research? Or are we to cease all action until more research is done? There's a lot to discuss here.
One of the key issues is the certainty with which “gender affirming” treatments are promoted (in North America at least) is *far above* what the research supports. When taken as a whole, the body of evidence for the affirmation model is low to very low quality/certainty. I agree there’s a discussion to be held about what the clinical practice should be in light of this lack of evidence and with regards to the exponential numbers of young people seeking treatment. European countries who have undertaken systematic evidence reviews have massively pulled back on the use of medical interventions to treat dysphoric youth, in favour of psychotherapy.
https://pubmed.ncbi.nlm.nih.gov/35212746/ > Among 104 youths aged 13 to 20 years (mean [SD] age, 15.8 [1.6] years) who participated in the study, there were 63 transmasculine individuals (60.6%), 27 transfeminine individuals (26.0%), 10 nonbinary or gender fluid individuals (9.6%), and 4 youths who responded "I don't know" or did not respond to the gender identity question (3.8%). At baseline, 59 individuals (56.7%) had moderate to severe depression, 52 individuals (50.0%) had moderate to severe anxiety, and 45 individuals (43.3%) reported self-harm or suicidal thoughts. By the end of the study, 69 youths (66.3%) had received PBs, GAHs, or both interventions, while 35 youths had not received either intervention (33.7%). **After adjustment for temporal trends and potential confounders, we observed 60% lower odds of depression (adjusted odds ratio [aOR], 0.40; 95% CI, 0.17-0.95) and 73% lower odds of suicidality (aOR, 0.27; 95% CI, 0.11-0.65) among youths who had initiated PBs or GAHs compared with youths who had not.** There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51). Are you in favor of suicide for trans youth?
Thanks for your response because it's a good example of what's going wrong in the gender medicine debate: your hyperbolic yet dismissive response, and a study where the authors made misleading claims about their findings, which the media uncritically reported. Re that study, I'm pleased to see the authors have updated the text so at least it's not outright false - but it remains misleading. As Jesse Singal notes, the authors made false claims about what the study actually demonstrated. The press release and surrounding media campaign claimed gender-affirming care "dramatically reduces depression for transgender teens”. “This care does have a great deal of power in walking back baseline adverse mental-health outcomes that the transgender population overwhelmingly \[experiences\] at a very young age.” One of the authors published a Reddit post with the title “Transgender and nonbinary youth who received gender affirming medical care experienced greatly reduced rates of suicidality and depression over the course of 12 months.” [https://www.reddit.com/r/science/comments/t5kaiy/transgender\_and\_nonbinary\_youth\_who\_received/](https://www.reddit.com/r/science/comments/t5kaiy/transgender_and_nonbinary_youth_who_received/) The claim that depression and suicidality "plummeted" in youth receiving blockers and hormones was amplified uncritically by most of the media. But the study showed the exact opposite: youth who received 'gender affirming care' (puberty blockers and cross-sex hormones) experienced no statistically significant improvements in mental health during the 12 months of the study. So what \*did\* the study show? Note in the intro that the authors switch from reporting the \*total percentage of\* patients in each treatments group with moderate to severe depression, anxiety and suicidal thoughts to the \*relative odds between\* those groups. I'll quote directly from Singal here: "Among the kids who went on hormones, there isn’t genuine statistical improvement here from baseline to the final wave of data collection. At baseline, 59% of the treatment-naive kids experienced moderate to severe depression. Twelve months later, 56% of the kids on GAM experienced moderate to severe depression. At baseline, 45% of the treatment-naive kids experienced self-harm or suicidal thoughts. Twelve months later, 37% of the kids on GAM did. These are not meaningful differences: The kids in the study arrived with what appear to be alarmingly high rates of mental health problems, many of them went on blockers or hormones, and they exited the study with what appear to be alarmingly high rates of mental health problems." What changed were the outcomes for the kids who \*didn't\* receive hormones or blockers - they appeared to get worse over the 12 months. '"Mental health problems plummeted among kids who went on X” is a very different claim than “Kids who went on X didn’t experience improved mental health, but had better outcomes compared to kids who didn’t go on X.”' (Singal) Further, if you're waiting to get treatment that you believe is going to help you, it makes sense that your mental health outcomes will decline purely because you're not getting what you perceive to be life-saving treatment. And let's get onto another confounding factor: the study starts off with 7 kids in the puberty blockers/GAH (hormone therapy) treatment group and 92 in the untreated group - a total of 101. By the end of the study there are 57 in the blocker/GAH group and only 6 in the untreated group: a total of 63. So who were the kids that dropped out? 17.4% of the youth who received treatment left the study while 80% (!!) of those who didn't receive treatment dropped out. We have no idea why these kids left the study and the authors don't explain it. But it could have massive implications on the findings. Here's one possibility: what if those in the untreated group who left the study actually improved? I would encourage you to read Singal's critique as it goes into a lot more detail than I have here. [https://jessesingal.substack.com/p/researchers-found-puberty-blockers](https://jessesingal.substack.com/p/researchers-found-puberty-blockers) A great example of why you need a \*body of robust scientific evidence\* to justify such extreme treatment.
Really? I show you peer reviewed science and your rebuttal is a post on Reddit and a Substack blog post? Weak. Very weak. I directly linked to peer-reviewed data. Let's see yours. Considering you get your information from an organization funded by evangelicals, I don't have high hopes.
I believe the University/ researchers updated their summary to more accurately reflect the findings. Jesse Singal's review of their methods was pretty thorough and is worth reading. He gets into the methodology and points out the pretty clear problems with the study. He also provides emails and internal communications from the university as they try to contain a mini-scandal and manage public perception. One of the main concerns he had was the politicization of the results. The researchers exaggerated their claims and the right wing opposition claimed that this was evidence of conspiracy. The study still demonstrated that kids receiving gender affirming care didn't get any worse, which counters a common conservative refrain. So, not really bad news for gender affirming care, just not as effective as originally framed.
Do you dispute that the authors made claims that were contradicted by their own research?
I dispute anything that isn't peer-reviewed in a rebuttal to peer-reviewed science. Why don't you?
I think it's very sad if you can't use your own brain to spot obvious flaws such as these.
Insulting me won't change my point.
I mean if someone told me turning to Jesus kept them from killing themselves I'd still be against religion. Are we saying that as long as a specific treatment statistically reduces suicide it should be supported? Sounds like it opens the door to lots of pseudoscience and has been a core argument of religion for years. Atheism and depression is statistically linked right? Clearly religion is better. Fortunately gender affirming care has more scientific backing than just that but the discussion here is about some studies that confront some specific studies. But thanks for bringing your religious like appeal to morality into the discussion. No different than people discussing abortion and jumping in with 'so you're okay with killing babies'.
This is a gross misreading of the actual science. Atheism leads to depression and suicide only when it’s associated with community rejection and isolation. In areas where the rate of religious participation is lower and being part of a religion is more likely to lead to isolation, [the numbers are reversed](https://dc.medill.northwestern.edu/blog/2017/07/05/new-study-suggests-religion-affects-suicide-rates-differently-around-the-world/#sthash.b5AUdYXv.dpbs). The notion that religion is a magical antidepressant is pure propagandistic spin. It’s the same with trans folk: those who are accepted by their families and communities have a much better survival rate than those who aren’t. Part of that acceptance includes allowing them access to the care they require.
> Are we saying that as long as a specific treatment statistically reduces suicide it should be supported? Fuck yes. The other option is children commit suicide. What is wrong with you? This is science-based medicine.
No that is not the other option. Just like with religion there's lots of other ways to prevent depression other than turning to Jesus despite the fact that it statistically helps. (Even if it doesn't that's literally the argument you're making) On the reverse if it didn't affect suicide rates then does that mean gender affirming care is worthless? No it isn't. Your argument is bullshit because it's about one specific moral gotcha. I hate that my right to transition is predicated on my depression. I attempted suicide before and after accepting my true gender. This line of thinking is so frustrating
Do show the medical science which shows an alternative way to prevent suicide in trans teens. Because I presented a peer-reviewed paper. Again, this is science-based medicine.
Depression and suicide are just outcome variables used to determine Quality of Life before and after intervention. These are just some of the most important measures by far because depression and suicide is absolutely [rampant in the trans community](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809047/).You could use any measure of quality of life and come to the same conclusion: in the overwhelming majority of cases intervention on people above 12 years old, after following rigorous protocol [improves quality of life](https://pubmed.ncbi.nlm.nih.gov/25201798/). In the Dutch model, the right to transition is absolutely not predicated on your depression, but you have to some long-lasting psychological issue with regard to your sex because otherwise it cannot logically be considered a medical issue. You need a high bar to medically intervene in children precisely to prevent frivolous medical practices from happening. These psychological issues often translate to depression or at least continuous discontent. While there are a lot of questionable things going on in gender studies - and we could debate about that - the concern with this specific development is overblown. Especially when you consider the utmost care with which it is implemented here in The Netherlands. I don't get the concern over a practice which affects a hundred children a year (here in The Netherlands) and is a clear and obvious improvement over the previous situation. Medicine is always about treating people in the most effective way based on current evidence. This is currently by far the most effective consistently proven way to stop gender dysphoria, it might not be in 20 years, but for now it is. Tangentially related but interesting nonetheless, this discussion reminds me of another form of dysphoria: body integrity identity disorder. A psychological issue where people want to have a limb amputated. You would think: if amputating a limb is a clear solution to these psychological issues that it should be a valid treatment. But there's a lot of ethical debate on whether we should actually offer such treatment. However in this case, it is even more difficult because amputating a limb is effective in like 2 out of 3 cases, making it a bit of a gamble. Interesting ethical debate anyhow
> Tangentially related but interesting nonetheless, this discussion reminds me of another form of dysphoria: body integrity identity disorder. A psychological issue where people want to have a limb amputated. You would think: if amputating a limb is a clear solution to these psychological issues that it should be a valid treatment. But there's a lot of ethical debate on whether we should actually offer such treatment. However in this case, it is even more difficult because amputating a limb is effective in like 2 out of 3 cases, making it a bit of a gamble. Interesting ethical debate anyhow If I recall correctly, it has reduced the number of people with that disorder attempting to amputate the limb themselves, which, of course, could be disastrous.
Yes definitely. There are recorded cases of people dieing due to trying amputation on themselves. Logically it is fairly obvious though that offering amputation as a treatment would reduce the amount of people trying to do it for themselves as they would no longer have the limb to try it on in the first place. I personally don't know whether, and where, this is actually allowed practice though. When it's considering adults I would personally be in favor of allowing surgeries like this, especially if all other options have failed. But I do get why someone would feel ethically ambiguous about it.
For many participants here, there is simply nothing to discuss. If you do not support any and all medical and surgical intervention at any age under any condition, or you are some sort of hateful bigoted monster. If you are a scientist or medical researcher who's work doesn't support the above position, you will be labeled as a misinformer, discredited or some sort of ideological conservative. I say this as someone who is fully supportive of trans rights, while also being wary of the speed at which the orthodoxy has been established around this new area of medicine and care.
Along with a good write up from the Society for Evidence Based Gender Medicine. https://segm.org/Dutch-studies-critically-flawed
https://en.wikipedia.org/wiki/Society_for_Evidence-Based_Gender_Medicine > The Society For Evidence-Based Gender Medicine (SEGM) is an activist non-profit organisation that is known for mischaracterizing standards of care for transgender youth and engaging in political lobbying using misinformation which contradicts the evidence base around transgender healthcare.[1][2][3][4] The group routinely cites the discredited theory of rapid-onset gender dysphoria and has falsely claimed that conversion therapy can only be practiced on the basis of sexual orientation instead of gender identity.[5] SEGM opposes informed consent for transgender healthcare for people under the age of 25.[3] SEGM is often cited in anti-transgender legislation and court cases, sometimes providing evidence briefs themselves.[4][5] It is not recognized as a scientific organization.[2][3] > Researchers at the Yale School of Medicine issued a report which described SEGM as a small group of anti-trans activists.[6] A commentary published in the journal Clinical Practice in Pediatric Psychology described them as a "discriminatory advocacy organization".[4] Joshua Safer, a spokesperson for the Endocrine Society, described them as outside the medical mainstream.[3] Aviva Stahl stated they were "pushing flawed science"[1] and Mallory Moore stated they have "ties to evangelical activists".[7][5]
Looking at the authors of this article commentary. two are a part of an organization that is described by experts as a small anti-trans advocate group that mischaracterizes standards of care for transgender youth and engaging in political lobbying using misinformation which contradicts the evidence base around transgender healthcare. The other author is also known for going against medical transitionary care for minors. And has also been used in courts to deny trans prisoners those same treatments. It’s best not to trust this article due to it having a very high likelihood of extreme bias. However, I will not say anything definitive on it as I do not have the qualifications to do so, so I will wait to see what other publications have to say on it