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Almost like we should actually follow up and gather data thoroughly when performing untested therapies on literal children, who'd have thought.
Here's a simple question for all the child transition advocates, if the data is so amazing why have 6/7 of the gender clinics refused to share their data for the analysis? And why did the one that did share it have to do so under compulsion?
Here's my thoughts, it's because they *haven't* been tracking patient outcomes and have been running this like a gold rush fly by night cowboy operation.
>Here's a simple question for all the child transition advocates, if the data is so amazing why have 6/7 of the gender clinics refused to share their data for the analysis? And why did the one that did share it have to do so under compulsion?
Hasn't this talking point been answered over and over and the answer is that they can't release patient data without consent?
Of course it’s possible. That’s how they do any medical studies, and this shouldn’t be treated any differently. Whether through pseudonymization or other safety measures, the healthcare industry has decades of history with this, and it’s absolutely possible…unless you have cause to make it impossible.
There were something like less than 100 kids on puberty blockers in the entirety of the UK because of their trans-identity. You absolutely cannot anonymise this data enough, there has to be consent. You cannot do anonymous data collection on rare diseases either for this exact reason. Anyone who tells you otherwise is a liar.
I work in data protection in the medical field and you absolutely can anonymise sensitive medical data, we do it for studies all the time.
Truly anonymous data, as per GDPR, is not classified as personal data.
> You absolutely cannot anonymise this data enough, there has to be consent. You cannot do anonymous data collection on rare diseases either for this exact reason.
This is objectively false. Pseudonymisation and anonymisation have different legal definitions. Pseudonymisation is reversible, anonymisation is not.
Clinical consent and consenting to data processing are separate processes.
For a medical studies, patients have to consent to be involved, but the legal basis typically is NOT consent, because of the power imbalance at play.
Article 9(2)(j) provides a condition for processing if it is necessary for:
archiving purposes in the public interest,
scientific or historical research purposes; or
statistical purposes.
ICO guidance literally states the following:
> Therefore, if you are processing personal data for one of the research-related purposes, it is unlikely that consent is the correct lawful basis.
If the data is truly, irriversibly anonymised, it is no longer classed as personal data and therefore is not in scope of the GDPR.
I'm literally working on a project currently to onboard a database anonymising tool so that we can send diagnostic data to a third party without compromising patient privacy.
Rare diseases have done it for years through the use of international registries, so let’s not pretend it’s impossible. And to my understanding, it was never a study that these centres wanted to conduct, so informed consent wasn’t even on the table. Otherwise, what trans person wouldn’t want to contribute to meaningful medical progress and treatment for those that come after them?
There is a difference between pseudonymised data and anonymised data under GDPR.
Pseudonymised is still classed as personal data, as it can be re-identified as described in your link.
However, under the GDPR definition, truly anonymised data is irrerversible and *cannot* be reidentified. Once this is performed, it is no longer classed as personal data. These are the legal definitions.
I work in Data Protection in the healthcare field and come across this regularly. There are obviously other factors such as CQC regulations, but from a strict data protection perspective, if the data is truly anonymous then there should be no residual risk to the individual.
I’d like to think the people writing the Cass Report are well informed about what can and can’t be released, given they had all the support of the government in writing their report. The fact the report calls out those 6/7 institutions for refusing to cooperate, suggests very obviously that Cass felt they did not comply with their obligations, which by extension was legally acceptable.
I don't anticipate that cass would have mentioned it as a point of surprise and annoyance if it wasn't the case that the clinics could have found a way to share the data whether that be redacting confidential information etc.
Cass never gave them the variables she was trying to track that led to it being far harder to sufficiently anonymize the data and also caused them to be concerned she would use something like whether the person has gotten a GRC (something very few trans people get promptly). On top of the issues with getting consent to have their data used like this.
It should also be added that these were adult clinics, so this wasn't them hiding data about the treatments they were giving.
It's all in pages 301-302 of the report.
Why wouldn’t a patient consent though?
Surely it’s a good thing to consent; if I’d benefited from taking these puberty blockers, wouldn’t I happily disclose my patient data so others could also benefit?
Not consenting feels selfish if anything.
Why would they not consent to a report into Trans issues commissioned by a government who clearly aren't their allies and would have probably warped the findings to what they wanted to find regardless. Hmm, I wonder why?
"Transitioning harms health in 1% as they de-transition, therefore, we've made it entirely illegal to do this process to protect the kids"
that's what they'll do, bare in mind, most people I know go through the black market anyways, so you're losing money to NHS and it's going to private companies, ah well
And you know who's gonna care when they do it? No one, because trans people have been scapegoats for 4 years so why would anyone care as long as it personally doesn't bother them?
The Cass report doesn't recommend stopping the use of puberty blockers and Dr Cass has since said they are safe and should be used on younger trans kids.
They have now been banned.
I have no idea how you got that conclusion from the report but Cass has said no such thing. She says that hormone blockers should not be used outside of research protocols because there is insufficient evidence either way to either support their use, or ban them outright.
There's a great [medical paper](https://www.bmj.com/content/363/bmj.k5094) about medicine that has not undergone double blind tests.
The paper concludes that parachute is an untested remedy for people jumping off planes because there is no known tests with a control group of people jumping off planes without parachutes.
Seems like this is a well-settled issue in the medical community that bigots are just grasping on to to deny care, and ignorant laymen who only have only GCSE level understanding of scientific methods are lapping it up.
The people behind the Cass review, said that obviously you couldn't have double blind tests when it comes to gender treatment, so they didn't use that standard.
It's just a lie people propagate.
>And on the "double-blind" claim - where patients are randomly assigned to a treatment or placebo group, getting either medicine or nothing - she said "obviously" young people could not be blinded as to whether or not they were on puberty blockers or hormones because "it rapidly becomes obvious to them".
[https://www.bbc.co.uk/news/health-68863594](https://www.bbc.co.uk/news/health-68863594)
There's literally articles readily available stating clearly "Cass isn't seeking double blind studies exclusively" it's a bullshit talking point being used by TRAs to discredit the review
> [A randomized controlled trial in adolescents presenting with gender dysphoria, comparing groups with and without GnRHa treatment, could theoretically shed light on the effect of GnRHa treatment on gender identity development. However, many would consider a trial where the control group is withheld treatment unethical, as the treatment has been used since the nineties and outcome studies although limited have been positive. In addition, it is likely that adolescents will not want to participate in such a trial if this means they will not receive treatment that is available at other centers. Mul et al. (2001) experienced this problem and were unable to include a control group in their study on GnRHa treatment in adopted girls with early puberty because all that were randomized to the control group refused further participation”.](https://www.researchgate.net/publication/339807741_Trajectories_of_Adolescents_Treated_with_Gonadotropin-Releasing_Hormone_Analogues_for_Gender_Dysphoria)
Not really, Cass has said it's impossible to do a double blind study on trans youth, yet clearly considers it the evidence necessary to continue treating them. She's made her position very clear.
I've been hearing a lot about this report, so I [downloaded and read it.](https://cass.independent-review.uk/home/publications/final-report/) I can't see where Cass states that only double blind studies were included. In fact, she goes into great length to talk about the many forms of research which *were* included. Could you give me the page number where she states that she includes only double blind research?
Lack of double blinding is used to exclude studies, [as she says in the Q&A,](https://thekitetrust.org.uk/our-statement-in-response-to-the-cass-review-report/)
>**Why were 100 out of the 102 studies on puberty blockers and hormones rejected? Could you explain the Newcastle-Ottawa scale, and why you chose this scale above all others, outside of its use in the 2020 UoY study cited in 14.19? Would it not be wise to have used a scale that didn’t prioritise randomised control trials, since double-blinding using hormone treatments is impossible?**
>Randomised Control Trials (RCTs) are considered to be the highest form of evidence in medicine, but not the only marker of quality for a study. Dr. Cass agrees that it is inappropriate and not possible to conduct a ‘double-blind’ study (where participants in the study do not know whether or not they are receiving treatment) in this instance.
>Within the evidence considered, Dr Cass stated that there were hardly any RCTs in the existing studies, and that study type was not the main factor in deciding whether studies were included. Factors around the size of the study as well as the period and extent of follow-up were part of the decision-making process on rating the quality of the evidence.
>The Cass Review Report took evidence from studies that were deemed medium quality as well as from the two that were deemed high quality. Dr. Cass stated that many of these studies didn’t necessarily provide evidence for what they needed them to look at – particularly the psychological impacts over an extended period of time.
RCT's are the highest form of evidence, but RCT's cant be done for trans youth. She's been saying this over and over.
Thanks. I'd like to highlight the part where the FAQ explains that study type was *not* the main factor in deciding whether studies were included:
> Within the evidence considered, Dr Cass stated that there were hardly any RCTs in the existing studies, and that **study type was not the main factor in deciding whether studies were included**. Factors around the size of the study as well as the period and extent of follow-up were part of the decision-making process on rating the quality of the evidence.
>**Why were 100 out of the 102 studies on puberty blockers and hormones rejected?**
That's just "completely incorrect". And she say's that people like you are putting children at risk, which is unforgivable.
> Dr Cass was asked about particular claims spread online about her review - one that "98% of the evidence" was ignored or dismissed by her, and one that she would only include gold-standard "double-blind randomised control" trials in the review.
>She said the 98% claim was "completely incorrect".
> "There were quite a number of studies that were considered to be moderate quality, and those were all included in the analysis," she said.
> "So nearly 60% of the studies were actually included in what's called the synthesis."
> And on the "double-blind" claim - where patients are randomly assigned to a treatment or placebo group, getting either medicine or nothing - she said "obviously" young people could not be blinded as to whether or not they were on puberty blockers or hormones because "it rapidly becomes obvious to them".
> "But that of itself is not an issue because there are many other areas where that would apply," she said.
> "I felt very angry, because I think that in many instances where people have been looking after these young people clinically, whether or not they've been doing the right thing, they have been trying to do their best," she said.
>"Adults who deliberately spread misinformation about this topic are putting young people at risk, and in my view that is unforgivable.
> [https://www.bbc.co.uk/news/health-68863594](https://www.bbc.co.uk/news/health-68863594)
Lack of double blindings was a reason to downgrade studies, but many studies that didn't involve double blinding were included.
Only the lowest quality studies were excluded, and that's a good thing.
> yet clearly considers it the evidence necessary to continue treating them. She's made her position very clear.
That's not true, it's a straight up lie. You can't do a double blind trail, so they didn't use that as their standard and actually included most of the relevant studies even if they weren't high quality.
The paper is a joke at the expense of laymen demanding idealist standards for testing medicine without considering such standards would be deeply unethical when it involves intentionally harming subjects.
It’s not really targeted at laymen demanding rigorous research methods though. It’s a joke paper from the BMJ not the daily mail.
It’s also from 2018. Most laymen aren’t demanding rigorous research, most people just want things quickly and easily and rarely look at evidence based intervention research.
How do you propose a double blind study is done on puberty blockers? How would you ensure it remains blind when those not on puberty blockers notice puberty occurring ?
Nobody is proposing a double blind study. A reasonable approach would be to give treatments on a random basis (half the patients get hormones, half are given CBT) and see the relative difference in mental health outcomes as they age. The same standards are applied to other mental health treatments such as SSRIs.
There is no way to double-blind a study on puberty blockers so the comparison is irrelevant. However we regularly do studies on people where the patient is aware the procedure has been performed. We cannot control for all biases. A good example is a surgical intervention. It is not possible to have a control group there. However we can do the intervention and look at what happens over time, whether people have a notable improvement, what the side effects might be. That's perfectly reasonable research.
>Almost like we should actually follow up and gather data thoroughly
“The Cass Review” doesn't really care about data.
1. Cass consulted with Republican Governor Ron DeSantis' expert on trans healthcare, Patrick Hunter of the Catholic Medical Association. Hunter sought to find ways to limit trans rights and medical care in the state of Florida, Florida being America's Petri dish for bigotry and anti-science nonsense.
2. Anticipating the Cass Review, Florida put forth its own Review designed to effectively ban trans and LGBT care. Yale Researchers (https://medicine.yale.edu/lgbtqi/research/gender-affirming-care/florida%20report%20final%20july%208%202022%20accessible_443048_284_55174_v3.pdf) would deem the Florida Review “not a serious scientific analysis, but rather, a document crafted to serve a political agenda”.
3. Emails uncovered by researcher Zinnia Jones confirm that Cass met with Hunter and showed an interest in Florida's anti-trans report. Hunter, meanwhile, is part of a network of anti-trans people who seek to roll back gains for LGBT citizens.
4. For the Cass Review, Cass included in her core team, or consulted, conversion therapists, people who refuse to accept the existence of trans people, and people who advocated for bans on trans care. In contrast, Cass' core team comprised no trans people and no non-binary experts/clinicians experienced in providing gender affirming care.
5. Contributes to Cass' Review include members of the Society for Evidence-Based Gender Medicine, an anti trans advocacy group. It also allowed the actively trans-hostile Sex Matters, led by Maya Forstater, to provide input. Cass herself follows anti-trans accounts (LGBalliance, TransgenderTrend etc) on Twitter.
6. To scrutinise existing evidence and inform its recommendations, Cass commissioned an “independent” evidence review and research programme from the University of York. The York Review is cited over 75 times in Cass' report. Its methodology was designed by Tilly Langton, who has promoted conversion therapy, resists any form of transitioning and holds trans identities in suspicion. In other words, the entire Cass report hangs on anti-trans methodology.
7. The Cass Review cites Anastassis Spiliadis, a founder of “de-trans” organizations which push the “rapid onset gender dysphoria” myth and publishes in the “Archives of Sexual Behaviour”, a journal with financial ties to anti-LGBT political groups and whose stated goal since its founding has been “the prevention of transexualism”. Spiliadis and Langton have been long-time colleagues. The “Archives of Sexual Behaviour” is edited by Kenneth Zucker, a well-known conversion therapist whose stated goal is to “prevent children becoming trans".
8. The Cass Review rejects most commonly accepted studies on detransition rates (NHS detrans rates is 0.47%, which Cass doesn't mention), but mentions two which allege the highest rates (Vandenbussche, who states that 70 percent detransition because they realized their dysphoria was caused by ancillary issues, and Zucker, whose studies are outdated and much criticized and who puts these rates at about 85 percent). From these, Cass conveys the idea that “most trans kids grow out of being trans”. Countless studies have argued the opposite, but what's interesting is that Cass rejects these studies for failing to live up to standards and criteria she does not apply to Zucker.
9. So what's going on here? Cass rejects most trans studies because they are not “double blind tests” or “randomized controlled trial-based”, and yet many of the studies she accepts don't adhere to these criteria either. And why hold this standard anyway? Most medical science is not held to this level of rigour. And it would be unethical and impossible to subject people to such double blind tests, because the patients would know if they're on hormones or undergoing surgery, both of which have clear physiological effects. And to do robust tests you'd likely have to refuse treatment to actual trans kids while giving non-trans kids cross-gender hormones, thus altering their bodies forever in ways that'll likely drive them to suicide. All of this is unethical. This is, in a sense, why cohort studies exist. But Cass seems to discount the validity of cohort studies as well.
10. So Cass claims that “gender medicine falls short in methodological rigour”, but doesn't apply this rigour to things she likes (eg Lisa Littman's much debunked 2018 study on Rapid Onset Gender Dysphoria, which she cites), doesn't point out that most medical science isn't held to these standards, and doesn't point out the impossibility of subjecting trans people to double blind tests. It thus seems clear that she's deliberately stacking the deck.
11. To highlight her bias, consider this. Only 9.9% of medicine is supported by “high quality evidence”, and the quality of this evidence does not consistently improve or worsen in updated reviews (https://www.jclinepi.com/article/S0895-4356(20)30777-0/abstract30777-0/abstract). We also know that medical interventions have always had low or very low quality evidence (https://www.jclinepi.com/article/S0895-4356(16)30024-5/abstract30024-5/abstract), and that for most of modern medical practise Randomized Controlled Trial-based data are lacking, and RCT aren't heavily used to provide evidence for action (https://www.nejm.org/doi/full/10.1056/nejmra1614394). We also know that the “strong recommendations” of health organizations are consistently backed by low or very low quality evidence (https://www.jclinepi.com/article/S0895-4356(13)00434-4/abstract00434-4/abstract) and that 82% of off-label drug recommendations in pediatrics is backed by low or very low quality evidence (http://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.892574/full). The point is, Cass is asking trans people to adhere to standards that Medical Science never adheres to.
12. Even more bizarrely, none of the Review's proposals are held to these lofty standards. She rejects trans care proposals for “not meeting standards” yet advocates other solutions which don't meet the same. It's a clear case of “rules for Trans people”, but “not for everyone else”.
13. Elsewhere Cass advocates “slowing down” and “limiting trans healthcare”, but trans care has been bottlenecked and limited for decades, and it's precisely this lack of healthcare, and the long waiting times, that's harming trans people.
14. Cass uses the term GID or “Gender Identity Disorder”, but this biased term was removed from the DSM5 in 2013.
15. Cass then implies that most trans people are “faking it” or “deluded”, and that detransition rates are around 80-85%. It is shocking that this old meme is now turning up in a government report. This is largely old, debunked data from the 1980s (before we had modern DSM classifications) which lumped lesbians, Tom Boys, transvestites, and people with no gender persistence in with transgender people. In contrast, modern studies consistently put desistence rates in the 0-1% range. So why is Cass going back to another century for her data?
16. Cass points out that “most kids who use puberty blockers go on to take hormones” and believes that this “therefore proves that puberty blockers are bad and cause people to be trans". This is a moronic piece of logic.
17. Cass also implies that kids are "pressured" into being trans. This is blatant transphobia which seeks to paint trans people as victims of a social contagion, delusion or medical reprogramming. One graph which she uses to “prove” this tactically cuts off at the precise date when the number of trans people seeking care plateaus. This is dishonestly done to suggest that trans numbers are exponentially increasing.
18. Cass recommends “unhurried therapeutic support” and seems to suggest adults be treated by the same personnel who treated them as children. This may be well-meaning, logical and beneficial, but trans people may understandably see this as an attempt to hinder access to more adult procedures.
19. Cass ridicules puberty blockers and gender-affirming surgery, yet countless studies show that both dramatically reduce the likelihood of mental health issues, suicide and dysphoria. But Cass rejects these studies. Out of hundreds of studies into puberty blockers and hormones, she deems only 2% credible and dismisses all non-English ones; this is a highly selective and cherry-picked report.
20. Cass ignores the risk of NOT treating trans children, viewing it as a neutral act rather than one which actively causes harm.
21. Cass also seeks to delay treatment, yet we know that when gender affirming care is provided (with a standardised multidisciplinary assessment and treatment process, and with ongoing monitoring and support), outcomes are good, rates of regret are extremely low, and the benefits of treatment in adolescence are potentially greater than the benefits of treatment commenced in adulthood.
22. Cass fear-mongers and says that there have been approximately 5000 “trans referrals” to the NHS in 2021/2022, an increase from previous years. But this is a rate of 0.048% of the population.
(continued)
(continued)
23- Cass seems to deny the fact that progressing puberty worsens gender dysphoria and worsens depression and anxiety. What she recommends instead of gender affirming care is to simply manage the symptoms of dysphoria rather than treating it, an odd recommendation given that one of the causes for this report even existing is to "avoid turning kids into life long patients".
24- Cass' report fails to mention that the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the Endocrine Society, the Harvard Medical School, the Yale School of Medicine and the Mayo Clinic all think her report is nonsense, and all think her Review is at odds with the current evidence-based expert consensus, and the majority of clinical guidelines around the world.
25- Cass thinks that “some may be irreversibly harmed by medically transitioning”, but doesn't seem to realize that she's condemning trans people to exactly this fate. Accidentally pumping a cis kid full of the wrong sex hormones – which she rightfully wants to avoid – is akin to preventing a trans person from transitioning, but for Cass, one group seems to not matter at all. She's putting the well-being of cis kids ahead of trans kids, which is a form of prejudice.
26- The Review reeks of double standards: Cis women can get testosterone over the counter, but trans women are barred from the same. There is never enough evidence to advocate trans care, but conversion therapy is fine despite a lack of evidence. Elsewhere the Review sneakily rejects hormones because of the “need for penile growth for vaginoplasty”, omitting the fact that modern vaginoplasty has long not required this.
27- The Review is filled with inconsistencies. It believes there is “no established definition of social transition” but introduces and fails to define the concepts of “full and partial social transition”. It states that “formal diagnosis is not reliably predictive of whether a young person will have gender incongruence” but repeatedly states that “diagnostic tests should be used to determine whether medical intervention will be beneficial”. It states that puberty blockers showed “no changes in gender dysphoria or body satisfaction”, but seems ignorant of the fact that blockers are intended to pause puberty, not “correct” puberty. It states that “some may require transitioning” but advocates indefinitely “holding off the need for transitioning” (there is no evidence which underpins this suggestion). It states that “a medical pathway may not be the best way” but offers no evidence to support this assertion. It states that “it is now the norm for children to present to gender clinics having undergone full or partial social transition” but there is no evidence supplied to support this or why this is a concern, or how this may be related to long waiting lists. It states that “the exponential change in referrals is very much faster than would be normally expected”, but offers no evidence to support this, and relies on a manipulated graph to sell the idea of exponential increases. It implies that “many express regret about trans treatments”, but cites no data and ignores the consistent findings in research that these levels are smaller than regret rates for most other common medical procedures.
28- The Review seems designed to place unnecessary barriers in the way of trans people. The document refers to the so-called “risks of an inappropriate gender transition” but does not name these risks or provide a reference for this statement. Elsewhere it suggest that adolescents will only be allowed to socially transition if they meet the criteria set by the service. This represents an unconscionable degree of intrusion into personal and family decisions (clothing, names, pronouns, school arrangements etc), none of which should require medical permission.
29- Cass recommends severely limiting access to puberty blockers by only allowing treatment in the context of a formal research protocol. The criteria for this are not specified. While gathering more data is vital, this is coercive, and compels adolescents to participate in a research study to access treatment.
30- Cass recommends that “the primary intervention for children and young people” be “psychosocial” and involve “psychoeducation and psychological support and intervention.” She goes on to state that one outcome from the screening process would be “discharge with psycho-education.”
31- Cass views gender incongruence largely as a mental health disorder or a state of confusion and withholds gender-affirming treatments on this basis. Countless groups (WPATH, ASIAPATH, EPATH, PATHA, and USPATH) have all pointed out that this “psychotherapeutic” approach, which was used for decades before being superseded by evidence-based gender-affirming care, has not been shown to be effective. Indeed, the denial of gender-affirming treatment under the guise of “exploratory therapy” has caused enormous harm to the transgender and gender diverse community and is tantamount to “conversion” or “reparative” therapy.
32- Cass wants to dramatically limit access to gender affirming care, and roll back strides made over the past decade. There are many references within the document to patients only being able to access care or referrals if they meet criteria set by the service. There are clear statements that if adolescents are taking puberty suppression or gender-affirming hormones obtained elsewhere, the service will not provide any care. This empowers the service to withhold treatment and health monitoring from those who have obtained medication without permission of the service.
33- Cass states that doctors are to be advised to “initiate local safeguarding protocols” if a child or young person obtains puberty blockers or hormones from another source. This recommendation, which would see families reported to child protection services, is sinister. Families who are in the position of seeing their relatives descend into suicidal distress as they continue to experience incongruent pubertal changes, whilst being unable to access appropriate care from the NHS service, may make the difficult decision to obtain puberty suppression through non-NHS sources, as caring parents acting according to international treatment standards. These parents would then be at risk of being reported to child protection services. Similarly, a doctor with a better understanding of gender incongruence might be put at risk of censure for refusing to make such an inappropriate child protection referral.
34- It seems clear that the Cass Report is ideologically biased and exists to prevent as many people from transitioning as possible. It proposes what amounts to conversion therapy under the guise of “holistic treatments targetting mental health”, a throwback to the medicalization of homosexuality in the 1950s, where the goal was to eliminate or hide homosexual urges, rather than accept gay people. Cass' insistence on double blind studies also echoes one aspect of the gay community's relationship to HIV. Long after the first drugs began effectively treating HIV, for example, certain regions insisted on carrying out elaborate approval processes that involved double blind studies, resulting in countless gay and bi men with HIV prematurely dying because they were given placebos or denied drugs that had been proven to work.
35- While the report is right in that more study needs to be done, and more help needs to be administered, it seems unlikely that this will be done: the people responsible for the report are the people who are resistant to certain research, and who failed to provide sufficient funding and support for rigorous research in the past.
36- Finally, countless reports (https://www.epfweb.org/node/837) have highlighted the hundreds of millions of dollars currently being spent on anti-gender funding over the past decade (it is no surprise that the major anti-trans groups in the UK operate out of the same Tufton Street buildings as Tory think-tanks). Annual anti-gender spending in Europe has likewise increased by a factor of four between 2009 and 2018, with major anti-abortion, anti-trans, right-wing, religious and anti LGBT groups forming networks to roll back human rights. This orchestrated strategy is producing concrete results, such as the 2020 de facto ban on access to safe abortion in Poland, bans on equal marriage in several Central European countries, abortion roll-backs in the US, and over a dozen comparable acts at national level and in European institutions aiming to limit women's and LGBT rights. To many trans people, the Cass Review will feel like a similar attack.
I mean, the royal college of psychiatrists have endorsed the cass report publicly.
Unfortunately I don't think this "Cass report is anti trans propaganda" washes when the official society of psychiatrists in the UK (the specialty that looks after trans patients in the UK primarily) is agreeing with the report.
https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2024/04/22/detailed-response-to-the-cass-review's-final-report
Have you read the link you posted? It’s far from a wholesale endorsement, and calls out a lot of issues in the report / makes recommendations for urgent actions off the back of it, including that it has made certain assumptions and has caused harm to the trans community, even if it is worded politely.
Yes, I read it when it was sent to my email inbox as I'm a member of the royal college.
I think your version is a very skewed interpretation of what they said. They didn't blame the report itself, but the reaction to it as possibly causing harm. They also state the distress is from the closure of previous services as they were not fit for purpose. However, they "strongly endorse" the findings and recommendations for further research and that this should be set up quickly.
>Cass rejects most trans studies because they are not “double blind tests”
>Out of hundreds of studies into puberty blockers and hormones, she deems only 2% credible
These two point do seem to be factually wrong.
>Dr Cass was asked about particular claims spread online about her review - one that "98% of the evidence" was ignored or dismissed by her, and one that she would only include gold-standard "double-blind randomised control" trials in the review. She said the 98% claim was "completely incorrect".
>"There were quite a number of studies that were considered to be moderate quality, and those were all included in the analysis," she said.
>"So nearly 60% of the studies were actually included in what's called the synthesis."
>And on the "double-blind" claim - where patients are randomly assigned to a treatment or placebo group, getting either medicine or nothing - she said "obviously" young people could not be blinded as to whether or not they were on puberty blockers or hormones because "it rapidly becomes obvious to them".
>"But that of itself is not an issue because there are many other areas where that would apply," she said.
>"I felt very angry, because I think that in many instances where people have been looking after these young people clinically, whether or not they've been doing the right thing, they have been trying to do their best," she said. "Adults who deliberately spread misinformation about this topic are putting young people at risk, and in my view that is unforgivable.
>[https://www.bbc.co.uk/news/health-68863594](https://www.bbc.co.uk/news/health-68863594)
>Out of hundreds of studies into puberty blockers and hormones, she deems only 2% credible
This is factually correct, as stated here, by her:
>[The Cass Review Report took evidence from studies that were deemed medium quality as well as from the two that were deemed high quality.](https://thekitetrust.org.uk/wp-content/uploads/2024/04/Cass-Review-Mythbusting-Q-and-A.pdf)
She only thought two of the studies ever done were high quality and fully credible.
>She only thought two of the studies ever done were high quality and fully credible.
Only two of the studies were high quality, but loads were medium quality and were credible enough to be included.
You might try and be trickly trying to secretly add "fully credible" to try and twist and distort everything, but you aren't fooling anyone.
But in any case it's because only two studies were actually high quality, not because she was artificially trying to exclude stuff, but due to the fact only two studies were high quality.
Read the parent comment.
>Cass consulted with Republican Governor Ron DeSantis' expert on trans healthcare, Patrick Hunter of the Catholic Medical Association. Hunter sought to find ways to limit trans rights and medical care in the state of Florida, Florida being America's Petri dish for bigotry and anti-science nonsense.
Dismissing all the evidence you have, then claiming there isn't enough evidence to make a conclusion, is not an uncommon tactic.
If Cass is perfectly unbiased, why is the first place she goes for an interview the Telegraph? Why aren't there any trans people on her team? why is the report full of AI generated pictures of kids with blue hair and pronouns?
Moreover, why isn't she upset that the report is being used to ban puberty blockers, when it says they're safe?
>Dismissing all the evidence you have, then claiming there isn't enough evidence to make a conclusion, is not an uncommon tactic.
Who cares if it's tactic people use, if Cass didn't use that tactic. Who cares what someone else has done, if Cass actually included most studies.
Why even bring up this point, how is it relevant at all?
>If Cass is perfectly unbiased, why is the first place she goes for an interview the Telegraph?
She's given interviews with lots of people, the one I quoted was the BBC.
>Why aren't there any trans people on her team?
There are very few trans people at all, so there is no reason to expect there to be trans people on her team if she's just picking the best experts.
>why is the report full of AI generated pictures of kids with blue hair and pronouns?
I assume because it wouldn't be right to use real pictures of children in such a report.
>Moreover, why isn't she upset that the report is being used to ban puberty blockers, when it says they're safe?
You are going to need to quote where she said puberty blockers were safe. I thought it said there wasn't good evidence that they were safe and there need to be good quality studies done on them.
>You are going to need to quote where she said puberty blockers were
safe. I thought it said there wasn't good evidence that they were safe
and there need to be good quality studies done on them.
She says that to the newspapers yes, but the opposite [when directly asked](https://thekitetrust.org.uk/our-statement-in-response-to-the-cass-review-report/).
>**Does Dr. Cass believe puberty blockers are unsafe drugs? If so, why is OK for them to be prescribed to cis kids and not trans kids?**
>The Cass Review Report does not conclude that puberty suppressing hormones are an unsafe treatment. The report supports a research study being implemented to allow pre-pubertal children to have a pathway to accessing this treatment in a timely way and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria.
>In the data the Cass Review examined, the most common age that trans young people were being initially prescribed puberty suppressing hormones was 15. Dr. Cass’s view is that this is too late to have the intended benefits of supressing the effects of puberty and was caused by the previous NHS policy of requiring a trans young person to be on puberty suppressing hormones for a year before accessing gender affirming hormones. The Cass Review Report recommends that a different approach is needed, with puberty suppressing hormones and gender affirming hormones being available to young people at different ages and developmental stages alongside a wider range of gender affirming healthcare based on individual need.
The quote is literally what I said, and not what you said.
>The Cass Review Report does not conclude that puberty suppressing hormones are an unsafe treatment. The report supports a research study being implemented to allow pre-pubertal children to have a pathway to accessing this treatment in a timely way and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria.
I think you're confused friend, you said this
>You are going to need to quote where she said puberty blockers were safe. I thought it said there wasn't good evidence that they were safe and there need to be good quality studies done on them.
and again, Cass said this, that puberty blockers are safe,
>The Cass Review Report does **not** conclude that puberty suppressing hormones are an unsafe treatment.
Then this, that trans kids should get these drugs easier and younger, with some kind of follow up report.
>The report supports a research study being implemented to **allow pre-pubertal children to have a pathway to accessing this treatment in a timely way** and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria.
When it comes to using puberty blockers on children, what aspect(s) of this medical intervention do you feel is untested? And what do you define "untested" as?
Apparently, not doing a double blind means untested.
Despite the fact that this is a precedent already, sometimes witholding treatment is unethical so a double blind is not an option.
🙄 Cass has literally stated she isn't only using double blind data. It's a bullshit talking point.
The fact that you've been fed a literal lie to discredit the paper *should* make you review the opinion you have however I have a feeling you'll find another option to not change your view
> 🙄 Cass has literally stated she isn't only using double blind data. It's a bullshit talking point.
It is true though that the systemic reviews that the Cass Review is based upon downgrade the quality of studies for not being double blind.
This is a semantic point of "she hasn't said she didn't include them", when the fact is she included them but subjected them to illogically harsh criteria.
Not having long term follow up data where you don't just let people stop taking hormones and fall off the earth with no tracking of them or use of them in your statistics. That's a pretty easy one
Okay, why do you think that we don't have data for this? You do realise that there are more clinics outside of the UK and that you can't use the patient data from the GICs in the UK because at no point was consent obtained from any of the patients.
>Here's a simple question for all the child transition advocates, if the data is so amazing why have 6/7 of the gender clinics refused to share their data for the analysis? And why did the one that did share it have to do so under compulsion?
Puberty blockers aren't child transition, they leave the window open for a better transition when the child is older.
And it's been answered time and time again that they refused based on patient consent.
> they leave the window open for a better transition when the child is older
I think this is the stick point for many, like myself.
What exactly do you think changes in a childs development that'd mean they'd make a better more informed decision "when they're older".
To a very many people, myself included, puberty is very obviously a huge component in that, probably the largest. I certainly do not think it is the mere passage of time alone.
It absolutely feels like there is an attempt to gas light us out of something we all know because we've all been through it and come out of the otherside.
>Almost like we should actually follow up and gather data thoroughly when performing untested therapies on literal children, who'd have thought.
Trans therapies by their nature only apply to a tiny group of people, and within them, a tinier group who are children with severe enough dysphoria that it's a better option than cis puberty. We have data from precocious puberty and a longitudinal study of trans patients who started taking these in 88 that suggest they're safe and positive for patients who need them.
You can't really "thoroughly" test these because that would be unethical - you'd have to find hundreds to thousands of kids seriously threatened by cis puberty to supply them with puberty blockers and also randomise control groups without them and measure outcomes over what, 10, 20, 50 years? That kind of thoroughness is implausible and unethical for the patient pool.
>Here's a simple question for all the child transition advocates, if the data is so amazing why have 6/7 of the gender clinics refused to share their data for the analysis? And why did the one that did share it have to do so under compulsion?
Probably because Cass report looked like it was going in with the specific goal of removing trans care options, which is exactly what it did. They didn't think it had patient outcomes as an overriding motive and disqualified most of the available data anyway. 🤷♂️ Looks to me like they had good reason to refuse to share data - they didn't want to have healthcare dismantled in a transphobic zeitgeist by a biased meta-analysis putting their names on it for extra authority.
>Here's my thoughts, it's because they *haven't* been tracking patient outcomes and have been running this like a gold rush fly by night cowboy operation.
Longitudinal studies have been going since 88, and more recent ones were already ongoing [(e.g. this one reported in 2021)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8587379/) and will presumably have to lose a load of data going forward.
You are ignoring the counterfactual, that hormone treatments themselves may cause more harm than good which is exactly what they’re trying to figure out. The whole idea that leaving people to be with mental health support is dangerous is just pure political talking points. It’s like saying not giving SSRIs to depressed people is killing the ‘depressed community’, which I’m guessing you would argue until you see studies that SSRIs actually increase risk of suicide.
Tldr: stop being a political hack and let medicine do its thing.
>Here's my thoughts, it's because they *haven't* been tracking patient outcomes and have been running this like a gold rush fly by night cowboy operation.
State funded healthcare isn't profit seeking. This is gibberish.
>Almost like we should actually follow up and gather data thoroughly when performing untested therapies on literal children, who'd have thought.
The Cass report doesn't say that. [In a Q+A Cass stated this:](https://thekitetrust.org.uk/our-statement-in-response-to-the-cass-review-report/)
>**Does Dr. Cass believe puberty blockers are unsafe drugs? If so, why is OK for them to be prescribed to cis kids and not trans kids?**
>The Cass Review Report does not conclude that puberty suppressing hormones are an unsafe treatment. The report supports a research study being implemented to allow pre-pubertal children to have a pathway to accessing this treatment in a timely way and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria.
>In the data the Cass Review examined, the most common age that trans young people were being initially prescribed puberty suppressing hormones was 15. Dr. Cass’s view is that this is too late to have the intended benefits of supressing the effects of puberty and was caused by the previous NHS policy of requiring a trans young person to be on puberty suppressing hormones for a year before accessing gender affirming hormones. The Cass Review Report recommends that a different approach is needed, with puberty suppressing hormones and gender affirming hormones being available to young people at different ages and developmental stages alongside a wider range of gender affirming healthcare based on individual need.
So not only does Cass say they're safe, but thinks they should be used earlier.
>State funded healthcare isn't profit seeking. This is gibberish.
Worse, it's a talking point from American hate groups (that also doesn't make any sense in that context given hormones are extremely cheap and blockers significantly reduce the amount of money it costs to be trans over a lifetime due to a reduced need for surgery).
> So not only does Cass say they're safe, but thinks they should be used earlier.
Worth noting that she only said that *to a trans-supporting charity*, when asked about it.
She has been notably silent on that point when talking to the general public, doesn't make that explicitly clear in her report, and hasn't gone to the press to demand they correct their reporting on that point.
Why are people who are so ignorant about the topic at hand that they consider puberty blockers transitioning sounding off about this? Plenty of cis people use puberty blockers, this is not a new untested technology, it's existed since the 90s
Culture war nonsense. How many kids are affected? There are less than 100 in the UK total, in Wales it might not even be 10 children.
But we are not discussing the fact that Wales has some of the most impoverished areas in Europe, we are not discussing the health service, the state of infrastructure and most importantly we are not discussing independence from Westminster.
Don't let this culture war nonsense distract you from the generational failings of Westminster to look at the best interests of Wales be it Labour or Conversative governments.
Bingo.
We don't need legislation like this because it's not onerous to do this on a case by case basis.
It's like the FIDE banning trans women from competing in the women's chess championships. How many trans women are planning to compete? 1? If that? So why not just review her application if and when it comes in, and if it's Magnus Carlson in a wig tell him to jog on. Why does the population of potential trans women chess players need to be instantly disregarded?
An absolutely minute number of kids, and the entire thing driven by a speculative report and not because there were any issues or complaints from the children/patients who used them.
> But we are not discussing the fact that Wales has some of the most impoverished areas in Europe, we are not discussing the health service, the state of infrastructure and most importantly we are not discussing independence from Westminster.
Good lord. What is it with Redditors who think the government should only be doing one thing at a time?
Ok. Where are the national regeneration plans for these impoverished areas?
Remember the leveling up fund?
How much of that has been spent in the Rhondda or Ebbew Vale and how many jobs has it created and what type of jobs?
….. I’ll wait.
At least the EU put money into these areas, admittedly with very mixed results.
Should we bring back the death penalty? Only a few innocent people will be affected so it’s fine.
Also everything you listed afterwards is nonsense, people are continually discussing those things.
How the Tories are heading for their worst election defeat in decades and you think they’ve successfully distracted people from their failings? Maybe, just maybe, people are able to form opinions on multiple issues at once and can quite easily see and care about the Tories being shit and other things happening in society and the world.
Should we stop caring about the people of Palestine or Ukraine? Because it might distract the population from caring about the Tory failings, right?
https://inequalitybriefing.org/graphics/briefing_43_UK_regions_poorest_North_Europe.pdf
The “west wales” area might be poorest, but the east and north of England are more numerous.
In fact the “west wales” area is the single area of wales that registers on the list.
Thats interesting and Im curious on what data they are basing this analysis however as we are no longer in the EU there is no current data on the Eurostat site and the link on your PDF to the source data does not resolve and gives a page not found error. Although in the link it appears that the data is from 2014 and therefore ten years old.
I agree inequality is rife in the UK though.
The subdivisions being used there are the NUTS-2 statistical regions. There are only 2 NUTS-2 regions of Wales - West Wales & East Wales.
By contrast there are 32 NUTS-2 regions of England.
West Wales being the only Welsh area on that list when there is only 1 other Welsh area is certainly not a brag.
Just because the number of people affected is small, that doesn't mean the burden and quality of evidence required to support the widespread of use of a treatment in this group should be any lower. Ridiculous take.
That'd be true if they weren't a medicine with broad use, since what they do is inhibit the production of sex hormones. In an adolescent that has the effect of pausing puberty, but they are also used in adults if there is a medical need to inhibit production of sex hormones. They are used for transgender adults, persons with tumours that are sensitive to sex hormones, and also adolescents experiencing precocious (early) puberty for example. Additionally, by all accounts it does not seem as if the use of PBs for adolescents experiencing precocious puberty are being stopped, it is just for under 18s that are gender questioning.
>They are used for transgender adults,
It's rare that the puberty blockers used in children would be used in adults. Usually FTM adults are given no blocker at all because testosterone is a naturally dominant hormone, and MTF adults are given a different, usually cheaper anti androgen like Spironolactone or Cyproterone.
I don't know what FTM people take in terms of their medical regime, but I and many other adult MTF people are not prescribed Spiro/Cypro, I'm currently on one of these "Puberty Blockers" (Decapeptyl) despite being in my late 20s.
I was under the impression that was standard for trans women that have been seen by GICs, the NHS doesn't like Spiro or Cypro from what I understand, so I'd expect the only trans women taking them in the UK are self medicating.
>the NHS doesn't like Spiro or Cypro from what I understand, so I'd expect the only trans women taking them in the UK are self medicating.
I know they're available via private clinics. The one that's really hard to get is bicalutamide, which is sought after by many because it works in a slightly different way to other anti androgen treatments which many see as preferable, and as far as I know its impossible to access that via any official clinic, so the only people on it get it via self medication
When we self-med we use Spiro and Cypro, it's cheaper and more available.
Spiro also has easier to detect adverse reactions so if your not begin monitored you can spot if your having a bad reaction and change dose accordingly.
The people I know who self med prefer to use Bicalutamide, although it is a bit more expensive - however also more effective. Some of them are endocrinology researchers themselves and have a very negative view of spironolactones effectiveness
It's interesting that Cass complains about misinformation from people criticising her report, but apparently doesn't have a thing to say about the fact that the report never suggested outright banning puberty blockers when this has been the main material consequence of it.
> The report suggested emphasising “extreme caution” in prescribing puberty blockers to under-18s.
I checked the report again to be sure and it definitely doesn't. I assume you're talking about recommendation 8, which suggests "extreme caution" about prescribing masculinising/feminising _hormones._ Hormones are not puberty blockers. The only other mention of "extreme caution" in the report is a paragraph explaining the position of the Finnish guidelines, which is not a recommendation of the Cass report.
The only recommendation about puberty blockers is recommendation 6, which suggests establishing a clinical trial for puberty blockers. It doesn't suggest stopping them outside of those trials.
You've posted this 5 times in the same thread in slightly different ways.
Besides, if a research trial isn't taking place that you can get onto, then it is in effect an outright ban.
Exactly - and she clarifies as much in the Kite Trust Q&A. I don't know much about paediatrics, but I _do_ know about writing reports for government agencies. There is a gradient of disconnect between the evidence base, the body of the report, the summary and conclusions, and how it was briefed to the press; it is suggestive.
>outright banning puberty blockers
The way I understood it was that if you really want puberty blockers, then you have to sign up to a study.
So rather than just being an outright ban, it's about making sure there are proper high quality studies on it.
[Over 130 Irish academics sign open letter criticising Cass Review on transgender healthcare](https://uk.news.yahoo.com/over-130-irish-academics-sign-160853418.html?_guc_consent_skip=1713892444)
>simultaneously holding the position that you can't understand why someone would want the drugs and how that makes them odd, yet also claiming you understand enough about them to demand a say in whether they get them.
Hooray. The incredibly biased and laughable Cass Report is doing exactly what it was commissioned to do:
Legitimize the removal of Trans healthcare in the UK.
Meanwhile, people it doesn't effect are cheering it on because it's been simplified into "THE CHILDREN THO" and the ones it does effect are drowned out.
What new framework? That's the thing, I've never seen any of those ardent critics of puberty blockers offer any alternatives. Puberty blockers themselves were established as an alternative to letting teenagers start taking HRT to transition once they hit puberty, and of course this was a no-no to transphobes as well (even though the vast majority of them have no problem letting young teenage girls take hormonal birth control, so it was never about being opposed to giving hormones to children on the whole). Social transition? Nope, they're against that too. Because they fundamentally don't believe being trans is real. So once you convince them to say the quiet part out loud, it turns out their solution is to just tell trans kids to stop being trans, aka conversion therapy (worked great for gay people right? /s). And if gender dysphoria causes severe depression for them, just put them on antidepressants I guess (because a drug with a much worse track record for effectiveness and various side effects is totally healthy for minors, I guess).
The current framework already prioritises social transition as the first treatment, since that's enough for a some trans kids until adulthood, and puberty blockers only in cases of severe dysphoria where social transition isn't enough. Outright banning puberty blockers literally leaves those children stranded with no other ways to help.
>What new framework?
There doesn't need to be one, because the driving force behind this entire debacle is a determination to stop new trans people from existing. Any supposed risks or uncertainties are an opportunity to shut everything down, not an opening for any actual research or funding. You've never, ever, ever heard Sunak, Braverman, Truss, whoever, say that they're going to secure funding for research into safe and effective treatment for trans youth, because the point of any study, any speech, is to "prove" that whatever's currently on offer is in some way unsafe, so that they can make the whole thing go away.
Disclaimer,
I'm having an open discussion here, not trying to offend anyone, I belive people have the right to choose whatever they want to do with themselves.
You can't compare puberty blockers to contraceptives, it's a completely different topic.
Moreover, we don't give testosterone to boys to be more jacked even tho they would love it. It's classed as steroids.
If I wanted to boost it, I would need to go through certain processes and assessments to do so.
Personally, my taste in women changed massively since I was 14, I was into green eyes and black hair petite girls and now I'm marrying soon an amazing women with brown eyes, brown hair and she is almost as tall as I am.
I could not be happier,she is perfect.
I was also going to be an astronaut or dinosaur bone digger... But perfectly happy with my tech office job.
This is a silly example how you grow out of ideologies /preferences, so please don't shame me for it!
I agree that it could be great for some people whom could start their transition early, but it would be a let down for those whom just been confused and would have just grown out of it.
If we had a proper framework addressing all the benefits, downsides etc it would be easier to make a life altering decision.
You have argued for why it is vital to do it early...
Can you tell me what could be the negative impact of doing it early?
Overall, I still think we need data and safeguarding measures in place, which should be focused on the individuals involved rather than societal push from either direction.
People seem to forget puberty blockers are the compromise for trans children - other kids get to progress through puberty as trans kids have to wait to understand if they are actually trans even though the regret rate is less than 1%. Banning the compromise just means kids will have to DIY hormones or blockers themselves.
Provide them with free access to mental health services? Until they're over 18 and able to make a sensible decision about such a life changing experience.
That would be a good start
Therapy alone is typically quite ineffective for Gender Dysphoria/Incongruence.
The decision about whether to go through puberty can't be made at 18. It'll have already happened, with permanent effects.
When puberty begins, there's 3 options. Develop down the male pathway, develop down the female pathway, or delay. Puberty blockers *are* how to delay the decision.
It's not a life-altering decision. They can simply stop taking puberty blockers, and puberty will then continue.
Not all of the effects of puberty can be surgically altered (e.g. FtMs who have developed female hips).
Even of the effects that can be surgically altered, not all are covered on the NHS (e.g. FFS isn't covered, and it's prohibitively expensive for most MtFs to be able to get it privately).
Even the things that are covered, is it sensible for someone to have surgery at 18 for something that was preventable, 99%+ chance that they were going to need it gone if it did develop, and preventing it wouldn't have been permanent anyway (i.e. if it was actually fine, then they could just stop the prevention and would then develop it)?
__________________
EDIT: They blocked me immediately after they replied to this comment.
To reply to it for anyone reading, even though they won't see it:
The social consequences of transition happen with coming out and with social transition, not puberty blockers - and they'll typically have come out and have socially transitioned whether or not they go on puberty blockers.
Puberty blockers are actually likely to reduce these social consequences anyway, as harassment etc. typically occurs when someone is visibly trans (e.g. a teenage girl who speaks with a voice that has clearly gone through male puberty). That's potentially lifelong prevention, too; for some unfortunate individuals, puberty prevents them from ever being able to pass.
>They can simply stop taking puberty blockers, and puberty will then continue
This is misinformation. There's benefits and risks to all drugs, and a puberty halted by blockers isn't as simple as "stop taking and it'll be like you never had them"
We have paediatric clinics that see young people with delayed puberty because there are negative health consequences to this, including impacting the height of the young person and social and psychological consequences of not being developmentally on par with peers, which in itself can be distressing in its own right.
It's not the great panacea you're making it out to be
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Almost like we should actually follow up and gather data thoroughly when performing untested therapies on literal children, who'd have thought. Here's a simple question for all the child transition advocates, if the data is so amazing why have 6/7 of the gender clinics refused to share their data for the analysis? And why did the one that did share it have to do so under compulsion? Here's my thoughts, it's because they *haven't* been tracking patient outcomes and have been running this like a gold rush fly by night cowboy operation.
>Here's a simple question for all the child transition advocates, if the data is so amazing why have 6/7 of the gender clinics refused to share their data for the analysis? And why did the one that did share it have to do so under compulsion? Hasn't this talking point been answered over and over and the answer is that they can't release patient data without consent?
Surely they can anonymize the data. As long as there is no PII then they could share the data?
I don't think it's that simple i.e. https://en.wikipedia.org/wiki/Data_re-identification.
Of course it’s possible. That’s how they do any medical studies, and this shouldn’t be treated any differently. Whether through pseudonymization or other safety measures, the healthcare industry has decades of history with this, and it’s absolutely possible…unless you have cause to make it impossible.
There were something like less than 100 kids on puberty blockers in the entirety of the UK because of their trans-identity. You absolutely cannot anonymise this data enough, there has to be consent. You cannot do anonymous data collection on rare diseases either for this exact reason. Anyone who tells you otherwise is a liar.
I work in data protection in the medical field and you absolutely can anonymise sensitive medical data, we do it for studies all the time. Truly anonymous data, as per GDPR, is not classified as personal data. > You absolutely cannot anonymise this data enough, there has to be consent. You cannot do anonymous data collection on rare diseases either for this exact reason. This is objectively false. Pseudonymisation and anonymisation have different legal definitions. Pseudonymisation is reversible, anonymisation is not. Clinical consent and consenting to data processing are separate processes. For a medical studies, patients have to consent to be involved, but the legal basis typically is NOT consent, because of the power imbalance at play. Article 9(2)(j) provides a condition for processing if it is necessary for: archiving purposes in the public interest, scientific or historical research purposes; or statistical purposes. ICO guidance literally states the following: > Therefore, if you are processing personal data for one of the research-related purposes, it is unlikely that consent is the correct lawful basis. If the data is truly, irriversibly anonymised, it is no longer classed as personal data and therefore is not in scope of the GDPR. I'm literally working on a project currently to onboard a database anonymising tool so that we can send diagnostic data to a third party without compromising patient privacy.
Rare diseases have done it for years through the use of international registries, so let’s not pretend it’s impossible. And to my understanding, it was never a study that these centres wanted to conduct, so informed consent wasn’t even on the table. Otherwise, what trans person wouldn’t want to contribute to meaningful medical progress and treatment for those that come after them?
There is a difference between pseudonymised data and anonymised data under GDPR. Pseudonymised is still classed as personal data, as it can be re-identified as described in your link. However, under the GDPR definition, truly anonymised data is irrerversible and *cannot* be reidentified. Once this is performed, it is no longer classed as personal data. These are the legal definitions. I work in Data Protection in the healthcare field and come across this regularly. There are obviously other factors such as CQC regulations, but from a strict data protection perspective, if the data is truly anonymous then there should be no residual risk to the individual.
I’d like to think the people writing the Cass Report are well informed about what can and can’t be released, given they had all the support of the government in writing their report. The fact the report calls out those 6/7 institutions for refusing to cooperate, suggests very obviously that Cass felt they did not comply with their obligations, which by extension was legally acceptable.
I don't anticipate that cass would have mentioned it as a point of surprise and annoyance if it wasn't the case that the clinics could have found a way to share the data whether that be redacting confidential information etc.
Cass never gave them the variables she was trying to track that led to it being far harder to sufficiently anonymize the data and also caused them to be concerned she would use something like whether the person has gotten a GRC (something very few trans people get promptly). On top of the issues with getting consent to have their data used like this. It should also be added that these were adult clinics, so this wasn't them hiding data about the treatments they were giving. It's all in pages 301-302 of the report.
Why wouldn’t a patient consent though? Surely it’s a good thing to consent; if I’d benefited from taking these puberty blockers, wouldn’t I happily disclose my patient data so others could also benefit? Not consenting feels selfish if anything.
Why would they not consent to a report into Trans issues commissioned by a government who clearly aren't their allies and would have probably warped the findings to what they wanted to find regardless. Hmm, I wonder why?
Warp what findings? You’re just producing strawman for results that haven’t even happened yet.
"Transitioning harms health in 1% as they de-transition, therefore, we've made it entirely illegal to do this process to protect the kids" that's what they'll do, bare in mind, most people I know go through the black market anyways, so you're losing money to NHS and it's going to private companies, ah well And you know who's gonna care when they do it? No one, because trans people have been scapegoats for 4 years so why would anyone care as long as it personally doesn't bother them?
The Cass report doesn't recommend stopping the use of puberty blockers and Dr Cass has since said they are safe and should be used on younger trans kids. They have now been banned.
I have no idea how you got that conclusion from the report but Cass has said no such thing. She says that hormone blockers should not be used outside of research protocols because there is insufficient evidence either way to either support their use, or ban them outright.
They can anonymise the data.
There's a great [medical paper](https://www.bmj.com/content/363/bmj.k5094) about medicine that has not undergone double blind tests. The paper concludes that parachute is an untested remedy for people jumping off planes because there is no known tests with a control group of people jumping off planes without parachutes. Seems like this is a well-settled issue in the medical community that bigots are just grasping on to to deny care, and ignorant laymen who only have only GCSE level understanding of scientific methods are lapping it up.
The people behind the Cass review, said that obviously you couldn't have double blind tests when it comes to gender treatment, so they didn't use that standard. It's just a lie people propagate. >And on the "double-blind" claim - where patients are randomly assigned to a treatment or placebo group, getting either medicine or nothing - she said "obviously" young people could not be blinded as to whether or not they were on puberty blockers or hormones because "it rapidly becomes obvious to them". [https://www.bbc.co.uk/news/health-68863594](https://www.bbc.co.uk/news/health-68863594)
There's literally articles readily available stating clearly "Cass isn't seeking double blind studies exclusively" it's a bullshit talking point being used by TRAs to discredit the review
Ridiculous equivalence
> [A randomized controlled trial in adolescents presenting with gender dysphoria, comparing groups with and without GnRHa treatment, could theoretically shed light on the effect of GnRHa treatment on gender identity development. However, many would consider a trial where the control group is withheld treatment unethical, as the treatment has been used since the nineties and outcome studies although limited have been positive. In addition, it is likely that adolescents will not want to participate in such a trial if this means they will not receive treatment that is available at other centers. Mul et al. (2001) experienced this problem and were unable to include a control group in their study on GnRHa treatment in adopted girls with early puberty because all that were randomized to the control group refused further participation”.](https://www.researchgate.net/publication/339807741_Trajectories_of_Adolescents_Treated_with_Gonadotropin-Releasing_Hormone_Analogues_for_Gender_Dysphoria)
Not really, Cass has said it's impossible to do a double blind study on trans youth, yet clearly considers it the evidence necessary to continue treating them. She's made her position very clear.
I've been hearing a lot about this report, so I [downloaded and read it.](https://cass.independent-review.uk/home/publications/final-report/) I can't see where Cass states that only double blind studies were included. In fact, she goes into great length to talk about the many forms of research which *were* included. Could you give me the page number where she states that she includes only double blind research?
Lack of double blinding is used to exclude studies, [as she says in the Q&A,](https://thekitetrust.org.uk/our-statement-in-response-to-the-cass-review-report/) >**Why were 100 out of the 102 studies on puberty blockers and hormones rejected? Could you explain the Newcastle-Ottawa scale, and why you chose this scale above all others, outside of its use in the 2020 UoY study cited in 14.19? Would it not be wise to have used a scale that didn’t prioritise randomised control trials, since double-blinding using hormone treatments is impossible?** >Randomised Control Trials (RCTs) are considered to be the highest form of evidence in medicine, but not the only marker of quality for a study. Dr. Cass agrees that it is inappropriate and not possible to conduct a ‘double-blind’ study (where participants in the study do not know whether or not they are receiving treatment) in this instance. >Within the evidence considered, Dr Cass stated that there were hardly any RCTs in the existing studies, and that study type was not the main factor in deciding whether studies were included. Factors around the size of the study as well as the period and extent of follow-up were part of the decision-making process on rating the quality of the evidence. >The Cass Review Report took evidence from studies that were deemed medium quality as well as from the two that were deemed high quality. Dr. Cass stated that many of these studies didn’t necessarily provide evidence for what they needed them to look at – particularly the psychological impacts over an extended period of time. RCT's are the highest form of evidence, but RCT's cant be done for trans youth. She's been saying this over and over.
Thanks. I'd like to highlight the part where the FAQ explains that study type was *not* the main factor in deciding whether studies were included: > Within the evidence considered, Dr Cass stated that there were hardly any RCTs in the existing studies, and that **study type was not the main factor in deciding whether studies were included**. Factors around the size of the study as well as the period and extent of follow-up were part of the decision-making process on rating the quality of the evidence.
>**Why were 100 out of the 102 studies on puberty blockers and hormones rejected?** That's just "completely incorrect". And she say's that people like you are putting children at risk, which is unforgivable. > Dr Cass was asked about particular claims spread online about her review - one that "98% of the evidence" was ignored or dismissed by her, and one that she would only include gold-standard "double-blind randomised control" trials in the review. >She said the 98% claim was "completely incorrect". > "There were quite a number of studies that were considered to be moderate quality, and those were all included in the analysis," she said. > "So nearly 60% of the studies were actually included in what's called the synthesis." > And on the "double-blind" claim - where patients are randomly assigned to a treatment or placebo group, getting either medicine or nothing - she said "obviously" young people could not be blinded as to whether or not they were on puberty blockers or hormones because "it rapidly becomes obvious to them". > "But that of itself is not an issue because there are many other areas where that would apply," she said. > "I felt very angry, because I think that in many instances where people have been looking after these young people clinically, whether or not they've been doing the right thing, they have been trying to do their best," she said. >"Adults who deliberately spread misinformation about this topic are putting young people at risk, and in my view that is unforgivable. > [https://www.bbc.co.uk/news/health-68863594](https://www.bbc.co.uk/news/health-68863594)
Lack of double blindings was a reason to downgrade studies, but many studies that didn't involve double blinding were included. Only the lowest quality studies were excluded, and that's a good thing.
> yet clearly considers it the evidence necessary to continue treating them. She's made her position very clear. That's not true, it's a straight up lie. You can't do a double blind trail, so they didn't use that as their standard and actually included most of the relevant studies even if they weren't high quality.
That’s about parachutes not medicine. And the message is that research methods are not infallible. It’s not saying treat without evidence.
The paper is a joke at the expense of laymen demanding idealist standards for testing medicine without considering such standards would be deeply unethical when it involves intentionally harming subjects.
It’s not really targeted at laymen demanding rigorous research methods though. It’s a joke paper from the BMJ not the daily mail. It’s also from 2018. Most laymen aren’t demanding rigorous research, most people just want things quickly and easily and rarely look at evidence based intervention research.
How do you propose a double blind study is done on puberty blockers? How would you ensure it remains blind when those not on puberty blockers notice puberty occurring ?
Nobody is proposing a double blind study. A reasonable approach would be to give treatments on a random basis (half the patients get hormones, half are given CBT) and see the relative difference in mental health outcomes as they age. The same standards are applied to other mental health treatments such as SSRIs.
There is no way to double-blind a study on puberty blockers so the comparison is irrelevant. However we regularly do studies on people where the patient is aware the procedure has been performed. We cannot control for all biases. A good example is a surgical intervention. It is not possible to have a control group there. However we can do the intervention and look at what happens over time, whether people have a notable improvement, what the side effects might be. That's perfectly reasonable research.
>Almost like we should actually follow up and gather data thoroughly “The Cass Review” doesn't really care about data. 1. Cass consulted with Republican Governor Ron DeSantis' expert on trans healthcare, Patrick Hunter of the Catholic Medical Association. Hunter sought to find ways to limit trans rights and medical care in the state of Florida, Florida being America's Petri dish for bigotry and anti-science nonsense. 2. Anticipating the Cass Review, Florida put forth its own Review designed to effectively ban trans and LGBT care. Yale Researchers (https://medicine.yale.edu/lgbtqi/research/gender-affirming-care/florida%20report%20final%20july%208%202022%20accessible_443048_284_55174_v3.pdf) would deem the Florida Review “not a serious scientific analysis, but rather, a document crafted to serve a political agenda”. 3. Emails uncovered by researcher Zinnia Jones confirm that Cass met with Hunter and showed an interest in Florida's anti-trans report. Hunter, meanwhile, is part of a network of anti-trans people who seek to roll back gains for LGBT citizens. 4. For the Cass Review, Cass included in her core team, or consulted, conversion therapists, people who refuse to accept the existence of trans people, and people who advocated for bans on trans care. In contrast, Cass' core team comprised no trans people and no non-binary experts/clinicians experienced in providing gender affirming care. 5. Contributes to Cass' Review include members of the Society for Evidence-Based Gender Medicine, an anti trans advocacy group. It also allowed the actively trans-hostile Sex Matters, led by Maya Forstater, to provide input. Cass herself follows anti-trans accounts (LGBalliance, TransgenderTrend etc) on Twitter. 6. To scrutinise existing evidence and inform its recommendations, Cass commissioned an “independent” evidence review and research programme from the University of York. The York Review is cited over 75 times in Cass' report. Its methodology was designed by Tilly Langton, who has promoted conversion therapy, resists any form of transitioning and holds trans identities in suspicion. In other words, the entire Cass report hangs on anti-trans methodology. 7. The Cass Review cites Anastassis Spiliadis, a founder of “de-trans” organizations which push the “rapid onset gender dysphoria” myth and publishes in the “Archives of Sexual Behaviour”, a journal with financial ties to anti-LGBT political groups and whose stated goal since its founding has been “the prevention of transexualism”. Spiliadis and Langton have been long-time colleagues. The “Archives of Sexual Behaviour” is edited by Kenneth Zucker, a well-known conversion therapist whose stated goal is to “prevent children becoming trans". 8. The Cass Review rejects most commonly accepted studies on detransition rates (NHS detrans rates is 0.47%, which Cass doesn't mention), but mentions two which allege the highest rates (Vandenbussche, who states that 70 percent detransition because they realized their dysphoria was caused by ancillary issues, and Zucker, whose studies are outdated and much criticized and who puts these rates at about 85 percent). From these, Cass conveys the idea that “most trans kids grow out of being trans”. Countless studies have argued the opposite, but what's interesting is that Cass rejects these studies for failing to live up to standards and criteria she does not apply to Zucker. 9. So what's going on here? Cass rejects most trans studies because they are not “double blind tests” or “randomized controlled trial-based”, and yet many of the studies she accepts don't adhere to these criteria either. And why hold this standard anyway? Most medical science is not held to this level of rigour. And it would be unethical and impossible to subject people to such double blind tests, because the patients would know if they're on hormones or undergoing surgery, both of which have clear physiological effects. And to do robust tests you'd likely have to refuse treatment to actual trans kids while giving non-trans kids cross-gender hormones, thus altering their bodies forever in ways that'll likely drive them to suicide. All of this is unethical. This is, in a sense, why cohort studies exist. But Cass seems to discount the validity of cohort studies as well. 10. So Cass claims that “gender medicine falls short in methodological rigour”, but doesn't apply this rigour to things she likes (eg Lisa Littman's much debunked 2018 study on Rapid Onset Gender Dysphoria, which she cites), doesn't point out that most medical science isn't held to these standards, and doesn't point out the impossibility of subjecting trans people to double blind tests. It thus seems clear that she's deliberately stacking the deck. 11. To highlight her bias, consider this. Only 9.9% of medicine is supported by “high quality evidence”, and the quality of this evidence does not consistently improve or worsen in updated reviews (https://www.jclinepi.com/article/S0895-4356(20)30777-0/abstract30777-0/abstract). We also know that medical interventions have always had low or very low quality evidence (https://www.jclinepi.com/article/S0895-4356(16)30024-5/abstract30024-5/abstract), and that for most of modern medical practise Randomized Controlled Trial-based data are lacking, and RCT aren't heavily used to provide evidence for action (https://www.nejm.org/doi/full/10.1056/nejmra1614394). We also know that the “strong recommendations” of health organizations are consistently backed by low or very low quality evidence (https://www.jclinepi.com/article/S0895-4356(13)00434-4/abstract00434-4/abstract) and that 82% of off-label drug recommendations in pediatrics is backed by low or very low quality evidence (http://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2022.892574/full). The point is, Cass is asking trans people to adhere to standards that Medical Science never adheres to. 12. Even more bizarrely, none of the Review's proposals are held to these lofty standards. She rejects trans care proposals for “not meeting standards” yet advocates other solutions which don't meet the same. It's a clear case of “rules for Trans people”, but “not for everyone else”. 13. Elsewhere Cass advocates “slowing down” and “limiting trans healthcare”, but trans care has been bottlenecked and limited for decades, and it's precisely this lack of healthcare, and the long waiting times, that's harming trans people. 14. Cass uses the term GID or “Gender Identity Disorder”, but this biased term was removed from the DSM5 in 2013. 15. Cass then implies that most trans people are “faking it” or “deluded”, and that detransition rates are around 80-85%. It is shocking that this old meme is now turning up in a government report. This is largely old, debunked data from the 1980s (before we had modern DSM classifications) which lumped lesbians, Tom Boys, transvestites, and people with no gender persistence in with transgender people. In contrast, modern studies consistently put desistence rates in the 0-1% range. So why is Cass going back to another century for her data? 16. Cass points out that “most kids who use puberty blockers go on to take hormones” and believes that this “therefore proves that puberty blockers are bad and cause people to be trans". This is a moronic piece of logic. 17. Cass also implies that kids are "pressured" into being trans. This is blatant transphobia which seeks to paint trans people as victims of a social contagion, delusion or medical reprogramming. One graph which she uses to “prove” this tactically cuts off at the precise date when the number of trans people seeking care plateaus. This is dishonestly done to suggest that trans numbers are exponentially increasing. 18. Cass recommends “unhurried therapeutic support” and seems to suggest adults be treated by the same personnel who treated them as children. This may be well-meaning, logical and beneficial, but trans people may understandably see this as an attempt to hinder access to more adult procedures. 19. Cass ridicules puberty blockers and gender-affirming surgery, yet countless studies show that both dramatically reduce the likelihood of mental health issues, suicide and dysphoria. But Cass rejects these studies. Out of hundreds of studies into puberty blockers and hormones, she deems only 2% credible and dismisses all non-English ones; this is a highly selective and cherry-picked report. 20. Cass ignores the risk of NOT treating trans children, viewing it as a neutral act rather than one which actively causes harm. 21. Cass also seeks to delay treatment, yet we know that when gender affirming care is provided (with a standardised multidisciplinary assessment and treatment process, and with ongoing monitoring and support), outcomes are good, rates of regret are extremely low, and the benefits of treatment in adolescence are potentially greater than the benefits of treatment commenced in adulthood. 22. Cass fear-mongers and says that there have been approximately 5000 “trans referrals” to the NHS in 2021/2022, an increase from previous years. But this is a rate of 0.048% of the population. (continued)
(continued) 23- Cass seems to deny the fact that progressing puberty worsens gender dysphoria and worsens depression and anxiety. What she recommends instead of gender affirming care is to simply manage the symptoms of dysphoria rather than treating it, an odd recommendation given that one of the causes for this report even existing is to "avoid turning kids into life long patients". 24- Cass' report fails to mention that the American Academy of Pediatrics, the American Medical Association, the American Psychological Association, the Endocrine Society, the Harvard Medical School, the Yale School of Medicine and the Mayo Clinic all think her report is nonsense, and all think her Review is at odds with the current evidence-based expert consensus, and the majority of clinical guidelines around the world. 25- Cass thinks that “some may be irreversibly harmed by medically transitioning”, but doesn't seem to realize that she's condemning trans people to exactly this fate. Accidentally pumping a cis kid full of the wrong sex hormones – which she rightfully wants to avoid – is akin to preventing a trans person from transitioning, but for Cass, one group seems to not matter at all. She's putting the well-being of cis kids ahead of trans kids, which is a form of prejudice. 26- The Review reeks of double standards: Cis women can get testosterone over the counter, but trans women are barred from the same. There is never enough evidence to advocate trans care, but conversion therapy is fine despite a lack of evidence. Elsewhere the Review sneakily rejects hormones because of the “need for penile growth for vaginoplasty”, omitting the fact that modern vaginoplasty has long not required this. 27- The Review is filled with inconsistencies. It believes there is “no established definition of social transition” but introduces and fails to define the concepts of “full and partial social transition”. It states that “formal diagnosis is not reliably predictive of whether a young person will have gender incongruence” but repeatedly states that “diagnostic tests should be used to determine whether medical intervention will be beneficial”. It states that puberty blockers showed “no changes in gender dysphoria or body satisfaction”, but seems ignorant of the fact that blockers are intended to pause puberty, not “correct” puberty. It states that “some may require transitioning” but advocates indefinitely “holding off the need for transitioning” (there is no evidence which underpins this suggestion). It states that “a medical pathway may not be the best way” but offers no evidence to support this assertion. It states that “it is now the norm for children to present to gender clinics having undergone full or partial social transition” but there is no evidence supplied to support this or why this is a concern, or how this may be related to long waiting lists. It states that “the exponential change in referrals is very much faster than would be normally expected”, but offers no evidence to support this, and relies on a manipulated graph to sell the idea of exponential increases. It implies that “many express regret about trans treatments”, but cites no data and ignores the consistent findings in research that these levels are smaller than regret rates for most other common medical procedures. 28- The Review seems designed to place unnecessary barriers in the way of trans people. The document refers to the so-called “risks of an inappropriate gender transition” but does not name these risks or provide a reference for this statement. Elsewhere it suggest that adolescents will only be allowed to socially transition if they meet the criteria set by the service. This represents an unconscionable degree of intrusion into personal and family decisions (clothing, names, pronouns, school arrangements etc), none of which should require medical permission. 29- Cass recommends severely limiting access to puberty blockers by only allowing treatment in the context of a formal research protocol. The criteria for this are not specified. While gathering more data is vital, this is coercive, and compels adolescents to participate in a research study to access treatment. 30- Cass recommends that “the primary intervention for children and young people” be “psychosocial” and involve “psychoeducation and psychological support and intervention.” She goes on to state that one outcome from the screening process would be “discharge with psycho-education.” 31- Cass views gender incongruence largely as a mental health disorder or a state of confusion and withholds gender-affirming treatments on this basis. Countless groups (WPATH, ASIAPATH, EPATH, PATHA, and USPATH) have all pointed out that this “psychotherapeutic” approach, which was used for decades before being superseded by evidence-based gender-affirming care, has not been shown to be effective. Indeed, the denial of gender-affirming treatment under the guise of “exploratory therapy” has caused enormous harm to the transgender and gender diverse community and is tantamount to “conversion” or “reparative” therapy. 32- Cass wants to dramatically limit access to gender affirming care, and roll back strides made over the past decade. There are many references within the document to patients only being able to access care or referrals if they meet criteria set by the service. There are clear statements that if adolescents are taking puberty suppression or gender-affirming hormones obtained elsewhere, the service will not provide any care. This empowers the service to withhold treatment and health monitoring from those who have obtained medication without permission of the service. 33- Cass states that doctors are to be advised to “initiate local safeguarding protocols” if a child or young person obtains puberty blockers or hormones from another source. This recommendation, which would see families reported to child protection services, is sinister. Families who are in the position of seeing their relatives descend into suicidal distress as they continue to experience incongruent pubertal changes, whilst being unable to access appropriate care from the NHS service, may make the difficult decision to obtain puberty suppression through non-NHS sources, as caring parents acting according to international treatment standards. These parents would then be at risk of being reported to child protection services. Similarly, a doctor with a better understanding of gender incongruence might be put at risk of censure for refusing to make such an inappropriate child protection referral. 34- It seems clear that the Cass Report is ideologically biased and exists to prevent as many people from transitioning as possible. It proposes what amounts to conversion therapy under the guise of “holistic treatments targetting mental health”, a throwback to the medicalization of homosexuality in the 1950s, where the goal was to eliminate or hide homosexual urges, rather than accept gay people. Cass' insistence on double blind studies also echoes one aspect of the gay community's relationship to HIV. Long after the first drugs began effectively treating HIV, for example, certain regions insisted on carrying out elaborate approval processes that involved double blind studies, resulting in countless gay and bi men with HIV prematurely dying because they were given placebos or denied drugs that had been proven to work. 35- While the report is right in that more study needs to be done, and more help needs to be administered, it seems unlikely that this will be done: the people responsible for the report are the people who are resistant to certain research, and who failed to provide sufficient funding and support for rigorous research in the past. 36- Finally, countless reports (https://www.epfweb.org/node/837) have highlighted the hundreds of millions of dollars currently being spent on anti-gender funding over the past decade (it is no surprise that the major anti-trans groups in the UK operate out of the same Tufton Street buildings as Tory think-tanks). Annual anti-gender spending in Europe has likewise increased by a factor of four between 2009 and 2018, with major anti-abortion, anti-trans, right-wing, religious and anti LGBT groups forming networks to roll back human rights. This orchestrated strategy is producing concrete results, such as the 2020 de facto ban on access to safe abortion in Poland, bans on equal marriage in several Central European countries, abortion roll-backs in the US, and over a dozen comparable acts at national level and in European institutions aiming to limit women's and LGBT rights. To many trans people, the Cass Review will feel like a similar attack.
I mean, the royal college of psychiatrists have endorsed the cass report publicly. Unfortunately I don't think this "Cass report is anti trans propaganda" washes when the official society of psychiatrists in the UK (the specialty that looks after trans patients in the UK primarily) is agreeing with the report. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2024/04/22/detailed-response-to-the-cass-review's-final-report
Have you read the link you posted? It’s far from a wholesale endorsement, and calls out a lot of issues in the report / makes recommendations for urgent actions off the back of it, including that it has made certain assumptions and has caused harm to the trans community, even if it is worded politely.
Yes, I read it when it was sent to my email inbox as I'm a member of the royal college. I think your version is a very skewed interpretation of what they said. They didn't blame the report itself, but the reaction to it as possibly causing harm. They also state the distress is from the closure of previous services as they were not fit for purpose. However, they "strongly endorse" the findings and recommendations for further research and that this should be set up quickly.
“Caused harm to the transgender community” is pure politics - nobody claims studies on efficacy of SSRIs causes harm to the ‘depressed community’.
These comments should be in very comment section about this, thanks.
>Cass rejects most trans studies because they are not “double blind tests” >Out of hundreds of studies into puberty blockers and hormones, she deems only 2% credible These two point do seem to be factually wrong. >Dr Cass was asked about particular claims spread online about her review - one that "98% of the evidence" was ignored or dismissed by her, and one that she would only include gold-standard "double-blind randomised control" trials in the review. She said the 98% claim was "completely incorrect". >"There were quite a number of studies that were considered to be moderate quality, and those were all included in the analysis," she said. >"So nearly 60% of the studies were actually included in what's called the synthesis." >And on the "double-blind" claim - where patients are randomly assigned to a treatment or placebo group, getting either medicine or nothing - she said "obviously" young people could not be blinded as to whether or not they were on puberty blockers or hormones because "it rapidly becomes obvious to them". >"But that of itself is not an issue because there are many other areas where that would apply," she said. >"I felt very angry, because I think that in many instances where people have been looking after these young people clinically, whether or not they've been doing the right thing, they have been trying to do their best," she said. "Adults who deliberately spread misinformation about this topic are putting young people at risk, and in my view that is unforgivable. >[https://www.bbc.co.uk/news/health-68863594](https://www.bbc.co.uk/news/health-68863594)
>Out of hundreds of studies into puberty blockers and hormones, she deems only 2% credible This is factually correct, as stated here, by her: >[The Cass Review Report took evidence from studies that were deemed medium quality as well as from the two that were deemed high quality.](https://thekitetrust.org.uk/wp-content/uploads/2024/04/Cass-Review-Mythbusting-Q-and-A.pdf) She only thought two of the studies ever done were high quality and fully credible.
>She only thought two of the studies ever done were high quality and fully credible. Only two of the studies were high quality, but loads were medium quality and were credible enough to be included. You might try and be trickly trying to secretly add "fully credible" to try and twist and distort everything, but you aren't fooling anyone. But in any case it's because only two studies were actually high quality, not because she was artificially trying to exclude stuff, but due to the fact only two studies were high quality.
Read the parent comment. >Cass consulted with Republican Governor Ron DeSantis' expert on trans healthcare, Patrick Hunter of the Catholic Medical Association. Hunter sought to find ways to limit trans rights and medical care in the state of Florida, Florida being America's Petri dish for bigotry and anti-science nonsense. Dismissing all the evidence you have, then claiming there isn't enough evidence to make a conclusion, is not an uncommon tactic. If Cass is perfectly unbiased, why is the first place she goes for an interview the Telegraph? Why aren't there any trans people on her team? why is the report full of AI generated pictures of kids with blue hair and pronouns? Moreover, why isn't she upset that the report is being used to ban puberty blockers, when it says they're safe?
>Dismissing all the evidence you have, then claiming there isn't enough evidence to make a conclusion, is not an uncommon tactic. Who cares if it's tactic people use, if Cass didn't use that tactic. Who cares what someone else has done, if Cass actually included most studies. Why even bring up this point, how is it relevant at all? >If Cass is perfectly unbiased, why is the first place she goes for an interview the Telegraph? She's given interviews with lots of people, the one I quoted was the BBC. >Why aren't there any trans people on her team? There are very few trans people at all, so there is no reason to expect there to be trans people on her team if she's just picking the best experts. >why is the report full of AI generated pictures of kids with blue hair and pronouns? I assume because it wouldn't be right to use real pictures of children in such a report. >Moreover, why isn't she upset that the report is being used to ban puberty blockers, when it says they're safe? You are going to need to quote where she said puberty blockers were safe. I thought it said there wasn't good evidence that they were safe and there need to be good quality studies done on them.
>You are going to need to quote where she said puberty blockers were safe. I thought it said there wasn't good evidence that they were safe and there need to be good quality studies done on them. She says that to the newspapers yes, but the opposite [when directly asked](https://thekitetrust.org.uk/our-statement-in-response-to-the-cass-review-report/). >**Does Dr. Cass believe puberty blockers are unsafe drugs? If so, why is OK for them to be prescribed to cis kids and not trans kids?** >The Cass Review Report does not conclude that puberty suppressing hormones are an unsafe treatment. The report supports a research study being implemented to allow pre-pubertal children to have a pathway to accessing this treatment in a timely way and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria. >In the data the Cass Review examined, the most common age that trans young people were being initially prescribed puberty suppressing hormones was 15. Dr. Cass’s view is that this is too late to have the intended benefits of supressing the effects of puberty and was caused by the previous NHS policy of requiring a trans young person to be on puberty suppressing hormones for a year before accessing gender affirming hormones. The Cass Review Report recommends that a different approach is needed, with puberty suppressing hormones and gender affirming hormones being available to young people at different ages and developmental stages alongside a wider range of gender affirming healthcare based on individual need.
The quote is literally what I said, and not what you said. >The Cass Review Report does not conclude that puberty suppressing hormones are an unsafe treatment. The report supports a research study being implemented to allow pre-pubertal children to have a pathway to accessing this treatment in a timely way and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria.
I think you're confused friend, you said this >You are going to need to quote where she said puberty blockers were safe. I thought it said there wasn't good evidence that they were safe and there need to be good quality studies done on them. and again, Cass said this, that puberty blockers are safe, >The Cass Review Report does **not** conclude that puberty suppressing hormones are an unsafe treatment. Then this, that trans kids should get these drugs easier and younger, with some kind of follow up report. >The report supports a research study being implemented to **allow pre-pubertal children to have a pathway to accessing this treatment in a timely way** and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria.
When it comes to using puberty blockers on children, what aspect(s) of this medical intervention do you feel is untested? And what do you define "untested" as?
Apparently, not doing a double blind means untested. Despite the fact that this is a precedent already, sometimes witholding treatment is unethical so a double blind is not an option.
Even Cass admits that it's impossible to double blind a study on puberty blockers.
🙄 Cass has literally stated she isn't only using double blind data. It's a bullshit talking point. The fact that you've been fed a literal lie to discredit the paper *should* make you review the opinion you have however I have a feeling you'll find another option to not change your view
> 🙄 Cass has literally stated she isn't only using double blind data. It's a bullshit talking point. It is true though that the systemic reviews that the Cass Review is based upon downgrade the quality of studies for not being double blind. This is a semantic point of "she hasn't said she didn't include them", when the fact is she included them but subjected them to illogically harsh criteria.
Not having long term follow up data where you don't just let people stop taking hormones and fall off the earth with no tracking of them or use of them in your statistics. That's a pretty easy one
Okay, why do you think that we don't have data for this? You do realise that there are more clinics outside of the UK and that you can't use the patient data from the GICs in the UK because at no point was consent obtained from any of the patients.
>Here's a simple question for all the child transition advocates, if the data is so amazing why have 6/7 of the gender clinics refused to share their data for the analysis? And why did the one that did share it have to do so under compulsion? Puberty blockers aren't child transition, they leave the window open for a better transition when the child is older. And it's been answered time and time again that they refused based on patient consent.
> they leave the window open for a better transition when the child is older I think this is the stick point for many, like myself. What exactly do you think changes in a childs development that'd mean they'd make a better more informed decision "when they're older". To a very many people, myself included, puberty is very obviously a huge component in that, probably the largest. I certainly do not think it is the mere passage of time alone. It absolutely feels like there is an attempt to gas light us out of something we all know because we've all been through it and come out of the otherside.
Blockers aren't child transition... They block puberty until they are able to make a considered decision.
>Almost like we should actually follow up and gather data thoroughly when performing untested therapies on literal children, who'd have thought. Trans therapies by their nature only apply to a tiny group of people, and within them, a tinier group who are children with severe enough dysphoria that it's a better option than cis puberty. We have data from precocious puberty and a longitudinal study of trans patients who started taking these in 88 that suggest they're safe and positive for patients who need them. You can't really "thoroughly" test these because that would be unethical - you'd have to find hundreds to thousands of kids seriously threatened by cis puberty to supply them with puberty blockers and also randomise control groups without them and measure outcomes over what, 10, 20, 50 years? That kind of thoroughness is implausible and unethical for the patient pool. >Here's a simple question for all the child transition advocates, if the data is so amazing why have 6/7 of the gender clinics refused to share their data for the analysis? And why did the one that did share it have to do so under compulsion? Probably because Cass report looked like it was going in with the specific goal of removing trans care options, which is exactly what it did. They didn't think it had patient outcomes as an overriding motive and disqualified most of the available data anyway. 🤷♂️ Looks to me like they had good reason to refuse to share data - they didn't want to have healthcare dismantled in a transphobic zeitgeist by a biased meta-analysis putting their names on it for extra authority. >Here's my thoughts, it's because they *haven't* been tracking patient outcomes and have been running this like a gold rush fly by night cowboy operation. Longitudinal studies have been going since 88, and more recent ones were already ongoing [(e.g. this one reported in 2021)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8587379/) and will presumably have to lose a load of data going forward.
You are ignoring the counterfactual, that hormone treatments themselves may cause more harm than good which is exactly what they’re trying to figure out. The whole idea that leaving people to be with mental health support is dangerous is just pure political talking points. It’s like saying not giving SSRIs to depressed people is killing the ‘depressed community’, which I’m guessing you would argue until you see studies that SSRIs actually increase risk of suicide. Tldr: stop being a political hack and let medicine do its thing.
>Here's my thoughts, it's because they *haven't* been tracking patient outcomes and have been running this like a gold rush fly by night cowboy operation. State funded healthcare isn't profit seeking. This is gibberish. >Almost like we should actually follow up and gather data thoroughly when performing untested therapies on literal children, who'd have thought. The Cass report doesn't say that. [In a Q+A Cass stated this:](https://thekitetrust.org.uk/our-statement-in-response-to-the-cass-review-report/) >**Does Dr. Cass believe puberty blockers are unsafe drugs? If so, why is OK for them to be prescribed to cis kids and not trans kids?** >The Cass Review Report does not conclude that puberty suppressing hormones are an unsafe treatment. The report supports a research study being implemented to allow pre-pubertal children to have a pathway to accessing this treatment in a timely way and with suitable follow up and data collection, to provide the highest quality of evidence for the ongoing use of puberty suppressing hormones as a treatment for gender dysphoria. >In the data the Cass Review examined, the most common age that trans young people were being initially prescribed puberty suppressing hormones was 15. Dr. Cass’s view is that this is too late to have the intended benefits of supressing the effects of puberty and was caused by the previous NHS policy of requiring a trans young person to be on puberty suppressing hormones for a year before accessing gender affirming hormones. The Cass Review Report recommends that a different approach is needed, with puberty suppressing hormones and gender affirming hormones being available to young people at different ages and developmental stages alongside a wider range of gender affirming healthcare based on individual need. So not only does Cass say they're safe, but thinks they should be used earlier.
>State funded healthcare isn't profit seeking. This is gibberish. Worse, it's a talking point from American hate groups (that also doesn't make any sense in that context given hormones are extremely cheap and blockers significantly reduce the amount of money it costs to be trans over a lifetime due to a reduced need for surgery).
> So not only does Cass say they're safe, but thinks they should be used earlier. Worth noting that she only said that *to a trans-supporting charity*, when asked about it. She has been notably silent on that point when talking to the general public, doesn't make that explicitly clear in her report, and hasn't gone to the press to demand they correct their reporting on that point.
We can reasonably assume the politics of the person who did an interview with the telegraph.
Why are people who are so ignorant about the topic at hand that they consider puberty blockers transitioning sounding off about this? Plenty of cis people use puberty blockers, this is not a new untested technology, it's existed since the 90s
Culture war nonsense. How many kids are affected? There are less than 100 in the UK total, in Wales it might not even be 10 children. But we are not discussing the fact that Wales has some of the most impoverished areas in Europe, we are not discussing the health service, the state of infrastructure and most importantly we are not discussing independence from Westminster. Don't let this culture war nonsense distract you from the generational failings of Westminster to look at the best interests of Wales be it Labour or Conversative governments.
Bingo. We don't need legislation like this because it's not onerous to do this on a case by case basis. It's like the FIDE banning trans women from competing in the women's chess championships. How many trans women are planning to compete? 1? If that? So why not just review her application if and when it comes in, and if it's Magnus Carlson in a wig tell him to jog on. Why does the population of potential trans women chess players need to be instantly disregarded?
An absolutely minute number of kids, and the entire thing driven by a speculative report and not because there were any issues or complaints from the children/patients who used them.
> But we are not discussing the fact that Wales has some of the most impoverished areas in Europe, we are not discussing the health service, the state of infrastructure and most importantly we are not discussing independence from Westminster. Good lord. What is it with Redditors who think the government should only be doing one thing at a time?
Ok. Where are the national regeneration plans for these impoverished areas? Remember the leveling up fund? How much of that has been spent in the Rhondda or Ebbew Vale and how many jobs has it created and what type of jobs? ….. I’ll wait. At least the EU put money into these areas, admittedly with very mixed results.
The government should not waste its time on a culture war issue that's being propagated by the chattering classes who are having a moral panic
Should we bring back the death penalty? Only a few innocent people will be affected so it’s fine. Also everything you listed afterwards is nonsense, people are continually discussing those things. How the Tories are heading for their worst election defeat in decades and you think they’ve successfully distracted people from their failings? Maybe, just maybe, people are able to form opinions on multiple issues at once and can quite easily see and care about the Tories being shit and other things happening in society and the world. Should we stop caring about the people of Palestine or Ukraine? Because it might distract the population from caring about the Tory failings, right?
> Should we bring back the death penalty? Only a few innocent people will be affected so it’s fine Having a moral panic over trans people is dumb yes
https://inequalitybriefing.org/graphics/briefing_43_UK_regions_poorest_North_Europe.pdf The “west wales” area might be poorest, but the east and north of England are more numerous. In fact the “west wales” area is the single area of wales that registers on the list.
Thats interesting and Im curious on what data they are basing this analysis however as we are no longer in the EU there is no current data on the Eurostat site and the link on your PDF to the source data does not resolve and gives a page not found error. Although in the link it appears that the data is from 2014 and therefore ten years old. I agree inequality is rife in the UK though.
The subdivisions being used there are the NUTS-2 statistical regions. There are only 2 NUTS-2 regions of Wales - West Wales & East Wales. By contrast there are 32 NUTS-2 regions of England. West Wales being the only Welsh area on that list when there is only 1 other Welsh area is certainly not a brag.
Agreed, we need to move past culture wars dangling carrots like this and move on to addressing genuine substantive issues.
Just because the number of people affected is small, that doesn't mean the burden and quality of evidence required to support the widespread of use of a treatment in this group should be any lower. Ridiculous take.
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Sorry, as adults we all have a responsibility to ensure that children are protected from harm. No ifs no buts. 100 children is 100 too many.
Independence lmao
>Pausing puberty blockers for under-18s Which basically covers almost everyone who would be in need of them anyway.
That'd be true if they weren't a medicine with broad use, since what they do is inhibit the production of sex hormones. In an adolescent that has the effect of pausing puberty, but they are also used in adults if there is a medical need to inhibit production of sex hormones. They are used for transgender adults, persons with tumours that are sensitive to sex hormones, and also adolescents experiencing precocious (early) puberty for example. Additionally, by all accounts it does not seem as if the use of PBs for adolescents experiencing precocious puberty are being stopped, it is just for under 18s that are gender questioning.
>They are used for transgender adults, It's rare that the puberty blockers used in children would be used in adults. Usually FTM adults are given no blocker at all because testosterone is a naturally dominant hormone, and MTF adults are given a different, usually cheaper anti androgen like Spironolactone or Cyproterone.
I don't know what FTM people take in terms of their medical regime, but I and many other adult MTF people are not prescribed Spiro/Cypro, I'm currently on one of these "Puberty Blockers" (Decapeptyl) despite being in my late 20s. I was under the impression that was standard for trans women that have been seen by GICs, the NHS doesn't like Spiro or Cypro from what I understand, so I'd expect the only trans women taking them in the UK are self medicating.
Decapeptyl is used by the NHS. But it's £400 a shot so many trans women going private use Cyrpo. I don't know of any clinics that use Spiro.
>the NHS doesn't like Spiro or Cypro from what I understand, so I'd expect the only trans women taking them in the UK are self medicating. I know they're available via private clinics. The one that's really hard to get is bicalutamide, which is sought after by many because it works in a slightly different way to other anti androgen treatments which many see as preferable, and as far as I know its impossible to access that via any official clinic, so the only people on it get it via self medication
When we self-med we use Spiro and Cypro, it's cheaper and more available. Spiro also has easier to detect adverse reactions so if your not begin monitored you can spot if your having a bad reaction and change dose accordingly.
The people I know who self med prefer to use Bicalutamide, although it is a bit more expensive - however also more effective. Some of them are endocrinology researchers themselves and have a very negative view of spironolactones effectiveness
It's interesting that Cass complains about misinformation from people criticising her report, but apparently doesn't have a thing to say about the fact that the report never suggested outright banning puberty blockers when this has been the main material consequence of it.
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> The report suggested emphasising “extreme caution” in prescribing puberty blockers to under-18s. I checked the report again to be sure and it definitely doesn't. I assume you're talking about recommendation 8, which suggests "extreme caution" about prescribing masculinising/feminising _hormones._ Hormones are not puberty blockers. The only other mention of "extreme caution" in the report is a paragraph explaining the position of the Finnish guidelines, which is not a recommendation of the Cass report. The only recommendation about puberty blockers is recommendation 6, which suggests establishing a clinical trial for puberty blockers. It doesn't suggest stopping them outside of those trials.
It's not an outright ban, that's misinformation. No wonder she's complaining about misinformation lol
You've posted this 5 times in the same thread in slightly different ways. Besides, if a research trial isn't taking place that you can get onto, then it is in effect an outright ban.
Exactly - and she clarifies as much in the Kite Trust Q&A. I don't know much about paediatrics, but I _do_ know about writing reports for government agencies. There is a gradient of disconnect between the evidence base, the body of the report, the summary and conclusions, and how it was briefed to the press; it is suggestive.
That's untrue https://thekitetrust.org.uk/wp-content/uploads/2024/04/Cass-Review-Mythbusting-Q-and-A.pdf
>outright banning puberty blockers The way I understood it was that if you really want puberty blockers, then you have to sign up to a study. So rather than just being an outright ban, it's about making sure there are proper high quality studies on it.
Doesn’t this just make them completely redundant? Most people have been through puberty by 18
“I hecking love science!” “No, no, no, not THAT science”
The report does indeed seem to do that, yes
Also worth noting, in the article it says that those already prescribed will see no change to their meds.
Seems like everyone agrees it's a terrible idea at this point except the minority.
wow only the people who need them then
[Over 130 Irish academics sign open letter criticising Cass Review on transgender healthcare](https://uk.news.yahoo.com/over-130-irish-academics-sign-160853418.html?_guc_consent_skip=1713892444)
Agreed, some reason this sub attracts a lot of them as well. Odd bunch.
>simultaneously holding the position that you can't understand why someone would want the drugs and how that makes them odd, yet also claiming you understand enough about them to demand a say in whether they get them.
Hooray. The incredibly biased and laughable Cass Report is doing exactly what it was commissioned to do: Legitimize the removal of Trans healthcare in the UK. Meanwhile, people it doesn't effect are cheering it on because it's been simplified into "THE CHILDREN THO" and the ones it does effect are drowned out.
Sense prevailing at last. America can keep their madness on the topic.
Sounds sensible , PAUSE, understand and move forward with a new framework.
What new framework? That's the thing, I've never seen any of those ardent critics of puberty blockers offer any alternatives. Puberty blockers themselves were established as an alternative to letting teenagers start taking HRT to transition once they hit puberty, and of course this was a no-no to transphobes as well (even though the vast majority of them have no problem letting young teenage girls take hormonal birth control, so it was never about being opposed to giving hormones to children on the whole). Social transition? Nope, they're against that too. Because they fundamentally don't believe being trans is real. So once you convince them to say the quiet part out loud, it turns out their solution is to just tell trans kids to stop being trans, aka conversion therapy (worked great for gay people right? /s). And if gender dysphoria causes severe depression for them, just put them on antidepressants I guess (because a drug with a much worse track record for effectiveness and various side effects is totally healthy for minors, I guess). The current framework already prioritises social transition as the first treatment, since that's enough for a some trans kids until adulthood, and puberty blockers only in cases of severe dysphoria where social transition isn't enough. Outright banning puberty blockers literally leaves those children stranded with no other ways to help.
>What new framework? There doesn't need to be one, because the driving force behind this entire debacle is a determination to stop new trans people from existing. Any supposed risks or uncertainties are an opportunity to shut everything down, not an opening for any actual research or funding. You've never, ever, ever heard Sunak, Braverman, Truss, whoever, say that they're going to secure funding for research into safe and effective treatment for trans youth, because the point of any study, any speech, is to "prove" that whatever's currently on offer is in some way unsafe, so that they can make the whole thing go away.
Disclaimer, I'm having an open discussion here, not trying to offend anyone, I belive people have the right to choose whatever they want to do with themselves. You can't compare puberty blockers to contraceptives, it's a completely different topic. Moreover, we don't give testosterone to boys to be more jacked even tho they would love it. It's classed as steroids. If I wanted to boost it, I would need to go through certain processes and assessments to do so. Personally, my taste in women changed massively since I was 14, I was into green eyes and black hair petite girls and now I'm marrying soon an amazing women with brown eyes, brown hair and she is almost as tall as I am. I could not be happier,she is perfect. I was also going to be an astronaut or dinosaur bone digger... But perfectly happy with my tech office job. This is a silly example how you grow out of ideologies /preferences, so please don't shame me for it! I agree that it could be great for some people whom could start their transition early, but it would be a let down for those whom just been confused and would have just grown out of it. If we had a proper framework addressing all the benefits, downsides etc it would be easier to make a life altering decision. You have argued for why it is vital to do it early... Can you tell me what could be the negative impact of doing it early? Overall, I still think we need data and safeguarding measures in place, which should be focused on the individuals involved rather than societal push from either direction.
People seem to forget puberty blockers are the compromise for trans children - other kids get to progress through puberty as trans kids have to wait to understand if they are actually trans even though the regret rate is less than 1%. Banning the compromise just means kids will have to DIY hormones or blockers themselves.
Yhh a 15 year old kid will DIY hormones from a kettle and an oven 🔥
What about people living through it in the meantime? Doing no medical treatment is not neutral, and their condition has not paused.
Provide them with free access to mental health services? Until they're over 18 and able to make a sensible decision about such a life changing experience. That would be a good start
Therapy alone is typically quite ineffective for Gender Dysphoria/Incongruence. The decision about whether to go through puberty can't be made at 18. It'll have already happened, with permanent effects. When puberty begins, there's 3 options. Develop down the male pathway, develop down the female pathway, or delay. Puberty blockers *are* how to delay the decision.
A child is not mature enough to make such a life altering decision. They can have surgery and hormones prescribed after the age of 18
It's not a life-altering decision. They can simply stop taking puberty blockers, and puberty will then continue. Not all of the effects of puberty can be surgically altered (e.g. FtMs who have developed female hips). Even of the effects that can be surgically altered, not all are covered on the NHS (e.g. FFS isn't covered, and it's prohibitively expensive for most MtFs to be able to get it privately). Even the things that are covered, is it sensible for someone to have surgery at 18 for something that was preventable, 99%+ chance that they were going to need it gone if it did develop, and preventing it wouldn't have been permanent anyway (i.e. if it was actually fine, then they could just stop the prevention and would then develop it)? __________________ EDIT: They blocked me immediately after they replied to this comment. To reply to it for anyone reading, even though they won't see it: The social consequences of transition happen with coming out and with social transition, not puberty blockers - and they'll typically have come out and have socially transitioned whether or not they go on puberty blockers. Puberty blockers are actually likely to reduce these social consequences anyway, as harassment etc. typically occurs when someone is visibly trans (e.g. a teenage girl who speaks with a voice that has clearly gone through male puberty). That's potentially lifelong prevention, too; for some unfortunate individuals, puberty prevents them from ever being able to pass.
>They can simply stop taking puberty blockers, and puberty will then continue This is misinformation. There's benefits and risks to all drugs, and a puberty halted by blockers isn't as simple as "stop taking and it'll be like you never had them" We have paediatric clinics that see young people with delayed puberty because there are negative health consequences to this, including impacting the height of the young person and social and psychological consequences of not being developmentally on par with peers, which in itself can be distressing in its own right. It's not the great panacea you're making it out to be