Puberty blockers

Bayswater being invited to participate in the puberty blocker ban consultation so shortly after the extent of their abuse towards trans children was exposed in the press reveals two things.

First, it emphasises the reluctance of UK institutions to recognise trans and young people as victims of a climate of hate that has pervaded British society.

But it is also telling that Streeting refuses to meet with one of the only groups of trans kids organising on their own. Streeting has met with trans children, but only alongside their parents or adult campaigners. Their presence helps Streeting to maintain the belief that trans kids lack the agency and maturity to make consequential decisions.

Trans Kids Deserve Better’s slogan – ‘we are not pawns for your politics’ – challenges this directly. Bayswater’s access to power relies on rendering their children as political pawns. Its status as a parents’ group lends it authority, even though most members would never admit to their children that they are part of the group.

Not giving agency to, or legitimising the opinions of, the children whose rights are at stake suits Streeting’s agenda.

Queensland’s controversial ban on puberty blockers and other hormone therapies is unlawful because of a failure to properly consult health executives on a decision affected by political interference, a court has heard.

The supreme court in Brisbane on Wednesday heard the ban should be overturned as part of a legal challenge launched by the mother of a transgender child. The mother cannot be identified for legal reasons.

Her lawyers told the court that Queensland Health’s director general, Dr David Rosengren, was required by law to consult with the executive of any service affected “in developing a health service directive” before he issued the order, banning such transgender hormone therapies for new patients aged under 18, on 28 January.

[…]

On the day the directive was issued, the state’s health executives were called to a Microsoft Teams meeting at 10am for consultation on the decision, which lasted 22 minutes.

At the same time as that meeting, Nicholls was announcing the decision at a press conference, the court was told.

Mark Steele KC, representing the mother, said Rosengren had signed off on publishing the health service directive an hour earlier and had repeatedly urged staff to ensure it was published at 10.30am.

The directive was published at 11.06am.

Steele told the court that Rosengren must have done so to line up with the end of Nicholls’ press conference.

“That can’t be genuine consultation if it’s just a fait accompli,” Steele told the court.

I emphatically reject the author's opinion that "it’s not ridiculous to suggest, for example, that a randomized trial of puberty blockers would be a good idea." (Why not a randomised trial of ambulances? We'll send half of emergency callers an Uber instead.) But he's certainly thorough, and excepts like this are astounding.

The Cass review was an interesting juxtaposition. Some of the scientific arguments were very reasonable, and the York team generally did a decent job with the systematic reviews that informed the document. However, the review itself often positioned bizarre theories about gender dysphoria alongside data and evidence. I’ve recounted quite a few examples of this during my pieces, but I thought I’d share one more that I found recently:

“Research commentators recommend more investigation into consumption of online pornography and gender dysphoria is needed. Some researchers (Nadrowski, 2023) suggest that exploration with gender-questioning youth should include consideration of their engagement with pornographic content.” (Cass review, page 110)

This paragraph suggests that porn can potentially turn children trans. If you look up the reference, it is to this opinion piece from a psychiatrist. The paper itself contains no data connecting gender dysphoria to pornography, but basically argues that teen girls may view porn and become so disgusted with being women that they choose to instead become men. The paper also notes that “Girls affected by autism might be at higher risk because of their reduced mentalization capacities.”, although it does not provide any evidence that this is true.

The author of this opinion piece is a psychiatric trainee who lists their affiliation as Therapy First. Therapy First is an explicitly anti-medication group which campaigns to prevent children from being given hormones or puberty blockers for gender dysphoria - instead, they recommend psychotherapy as the first and in many cases only option. This is not evidence. It’s barely even an opinion. There is no reasonable excuse for the Cass review having included such a completely bizarre and unsubstantiated theory, especially without noting that it is entirely unsupported by even the most vague of evidence.

Seriously: would you test the effectiveness of chemotherapy by giving a control group of cancer sufferers saline water? I mean, assuming you're not a raving lunatic who insists that cancer is a fashionable lifestyle choice spread by social contagion on TikTok?

The absence of RCTs studying the impact of gender-affirming care on the mental health and well-being of transgender adolescents does not imply that these interventions are insufficiently supported by evidence. Although RCTs are considered high-quality evidence because of their ability to control for unmeasured confounders, the impossibility of masking which participants receive gender-affirming interventions and the differential impact of unmasking on adherence, withdrawal, response bias, and generalizability compromises the value of RCTs for adolescent gender-affirming care. RCTs are methodologically inappropriate for studying the relationship between gender-affirming interventions and mental health. These methodological considerations compound the serious ethical concerns raised by RCTs in adolescent transgender healthcare. Given the limitations of RCTs, complementary and well-designed observational studies offer more reliable scientific evidence than RCTs and should be considered of sufficient quality to guide clinical practice and policymaking. Adolescent trans healthcare is on solid footing.