What the Science Says About Trans Teens on Puberty Blockers (CW: Self-Harm)
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Transcript:
Last month Ken Paxton, the current Attorney General of Texas, published a nonbinding opinion that parents who provide their trans kids with science-based medical care should be investigated for child abuse. This was quickly followed by Greg Abbott, the current governor of Texas, publishing a directive to the Department of Family and Protective Services to do just that. That department immediately placed one of their own employees on administrative leave pending an investigation into them for helping their 16-year old trans child through gender-affirming care. The department demanded the family turn over the teen’s medical records. The family refused and has enlisted the help of the ACLU of Texas and Lambda Legal, who have filed a lawsuit to block the records request and challenge the legitimacy of Abbott’s order.
This is all, obviously, a gigantic clusterfuck that puts trans kids and their families at serious risk. So I just want to talk about it a little bit and go over a few things that seem to be confusing people, including myself at first.
First of all, what is the “gender-affirming care” that is suddenly considered child abuse in Texas? Well, Abbott’s directive to the DFPS lists the following: “reassignment surgeries that can cause sterilization, mastectomies, removals of otherwise healthy body parts, and administration of puberty-blocking drugs or supraphysiologic doses of testosterone or estrogen.”
Let’s take those in order. Surgeries DO sound like a big deal: maybe we SHOULD restrict teens from getting elective surgery that might be difficult or impossible to reverse, right? Well, it turns out that we already do: current medical guidelines by and large suggest that teens wait until they’re 18 to have procedures like genital or chest surgeries, usually after they’ve been on hormones for some time. Rarely, teens as young as 16 have been evaluated and found to be of sure enough mind to have surgery.
So, we can dismiss that as something that doesn’t really happen. Abbott also mentions puberty blockers, though, and that DOES tend to be prescribed for teens under the age of 18. So what are they, and why do people like Abbott think that they’re abusive for teens?
Puberty blockers do essentially what it says on the tin: they press the “pause” button on the flood of hormones we get when we enter puberty. They are completely reversible, in that once you decide you want to start puberty, you simply stop taking the blockers and boom, your hormones leap into action. Most puberty blockers are gonadotropin-releasing hormone (GnRH), delivered into the body via monthly injections or through an implant in the arm, just like this one I have in my arm that releases progestin into my body to prevent me from getting preggers. That’s right, I’m a cyborg and it’s fucking awesome.
Anyway, puberty blockers have been around for decades and are used to treat a variety of problems, including cancers that are affected by sex hormones like prostate cancer. Some kids experience puberty way earlier than normal which can cause a variety of issues, so they take the blockers until they’re closer to 10 or 11. Then they stop and have a totally normal puberty.
For trans kids, they can be a godsend (or a science-send I guess): you can probably imagine that if you fervently believe you are, say, a girl, things may get really upsetting when you start getting random erections and sprouting heavy facial hair. Hell, I find it upsetting when I sprout heavy facial hair and I’m not even trans.
Teens can start puberty blockers any time after puberty begins, usually 12 or so at the earliest. They help by giving a trans teen TIME: time to consider what they truly want, or time to get ready for what’s coming down the road. Once they’re older (current recommendations are 16, but exceptions as young as 14 can be made for very mature teens) they can decide to go off the blockers and either experience puberty as the sex they were assigned at birth or start taking hormones to essentially experience puberty as the opposite sex. After a year or more on hormones, they can then decide around the age of 18 if they want to proceed with surgeries.
So why do people like Abbott consider puberty blockers “child abuse” if a teen can go off them at any time and experience puberty like normal? Well, this was kind of tough to nail down, for the main reason that puberty blockers are overwhelmingly safe with little to no known negative side effects.
But opponents claim a few things about puberty blockers: one, that they’re irreversible (they are, as mentioned, easily reversible). And two, that they may cause loss of bone density and sterility later in life. I’ve even seen those things mentioned in places like the Mayo Clinic’s site, but they say blockers MAY cause these things. That’s not good enough for me so after reading far more research on this than I’d honestly like, it appears to me that the medical consensus is that none of that is true: puberty blockers do NOT cause loss of bone density or sterility. A systematic review of the literature by “authors designated by multiple pediatric endocrinology societies from around the globe” found “Adverse effects of GnRHa therapy are rare, and the associations of most reported adverse events with the GnRHa molecule itself are unclear. Decades of experience have shown that GnRHa treatment is both safe and efficacious.”
Further, “There is no substantiated evidence that GnRHa treatment impairs reproductive function or reduces fertility,” and in regards to bone density, while “GnRHa treatment slows mineral accrual, after discontinuation BMD appears not to be significantly different from that of their peers by late adolescence. Reports of BMD among children and adolescents verified a decrement in BMD at the achievement of near AH, while accrual resumed after therapy, regardless of whether or not calcium supplementation was given. By late adolescence, all subjects had BMD within the normal range.”
Note that these were kids who experienced early puberty and they had heavier bone density prior to taking blockers, but even if trans kids did experience a loss of density that’s something they and their doctor could watch for and control either by switching to a different puberty blocker or by taking medications to increase bone growth. In other words, even if it does happen in rare cases it’s simply not a big deal.
We know all this because we have DECADES of research on puberty blockers used not just in trans teens but in countless kids with “precocious puberty” (the medical term, which makes it sound cuter than it is). Puberty blockers are safe, easily accessible, and easily stopped and the body naturally “reverses” them.
So to recap, the more-or-less ideal timeline goes something like this: you’re a child who feels gender dysphoria prior to puberty and your parent supports you with an environment that’s friendly and non judgemental. Wear the clothes you like. Cut your hair how you want. Use whatever pronouns you fancy. When puberty hits around 10 or 11, you discuss blockers with your doctor. You can go through puberty or delay its onset while you think more about who you are and who you want to be. You take the puberty blockers for a few years, and at 16 you decide that yes, you would like to transition to the opposite sex. You discuss it with your parents and your doctor and begin taking the hormones for whichever sex you’re transitioning to. You begin growing body hair and muscles and breasts and whatnot, and after a year or two on hormones you get a better idea of how your new body will feel, so you can decide one of three paths: “detransition” back to the sex you were assigned at birth which will require different hormone treatments, continue taking the hormones you’ve been on for longer, or undergoing surgery. You’re now 18 and if you’d like, you can make these decisions without your parents’ consent because you are an adult.
None of what I described is child abuse. What COULD be considered child abuse is the ideal situation imagined by people like Greg Abbott: your thoughts about how you feel in your own body are suppressed throughout childhood and when puberty arrives it’s terrifying and painful and confusing. You suddenly think about killing yourself at a rate twice that of your peers. You have a 40% chance of following through with that thought.
There’s a reason doctors refer to the use of puberty blockers in trans youth as literally “life-saving”. A large-scale survey conducted last December found that gender-affirming care for trans and nonbinary teens resulted in a signficant drop in depression, suicidal thoughts, and suicide attempts, and then ANOTHER big study published just last week found exactly the same: “gender-affirming medical interventions were associated with lower odds of depression and suicidality over 12 months. These data add to existing evidence suggesting that gender-affirming care may be associated with improved well-being among TNB youths over a short period, which is important given mental health disparities experienced by this population, particularly the high levels of self-harm and suicide.”
The science on this is crystal clear: the rational guidelines doctors have set up to treat kids with gender dysphoria are working. They aren’t just safe, they’re necessary to save lives. They’re saving and improving lives. As we’ve seen with other issues like abortion care, doctors and scientists have no need for politicians like Greg Abbott to insert themselves where they do not belong.
I’m so incredibly proud of the Texas families that are fighting back. It’s brave enough to support your kid who probably turned out a lot different than you had expected, and who probably brings a lot of heat on you for not “conforming.” To not only do that but to then step up and say “Fuck Greg Abbott, fuck the prospect of fines and jail time and CPS investigations: I’m going to love my kid the way they deserve to be loved”…my heart is with them.
If you’d like to support these families and these teens, you can donate now to Lamda Legal, which is not only fighting for transgender lives in Texas but also across the country. I have ads on this video and will be donating 100% of the ad revenue to Equality Texas, a nonprofit that fights for the rights of LGBTQI people across the state via political action. Thanks for watching and please stay safe!
Your analysis of the safety and effectiveness of puberty blockers is at odds with various recent reviews by national academies and authorities.
The Swedish National Board of Health and Welfare have recently looked at the evidence and concluded that the evidence base is of low quality and insufficient to draw the type of absolute conclusions you have done. They note the risks appear to outweigh the benefits and puberty blockers should only be given in “exceptional circumstances”. They note the increased understanding of detransitioners and also our lack of good data on why so many young people now present.
https://segm.org/segm-summary-sweden-prioritizes-therapy-curbs-hormones-for-gender-dysphoric-youth
The National Academy of Medicine in France has also just advised caution. They note “that it is not possible to distinguish a durable trans identity from a passing phase of an adolescent’s development.” As such, “Children and adolescents expressing a desire to transition, as well as their families, should receive extended psychological support”. They also take seriously the Littman hypothesis of ROGD/social contagion and say “Parents addressing their children’s questions about transgender identity or associated distress should remain vigilant regarding the addictive role of excessive engagement with social media”.
https://segm.org/France-cautions-regarding-puberty-blockers-and-cross-sex-hormones-for-youth
The Australia and New Zealand College of Psychiatrists have dropped recommendations to follow a puberty blocker course and say “Assessment and treatment should be evidence-informed, fully explore the patient’s gender identity, the context in which this has arisen, other features of mental illness and a thorough assessment of personal and family history. ”
The UK National Institute for Health and Care Excellence (NICE) has also undertaken systematic reviews of pubery blockers. “The reviewers cautioned that all the studies evaluated had results of “very low” certainty, and were subject to bias and confounding.”
Why does your analysis differ so markedly from these various organisations? What have you seen that they have not?
I poked around on the site you link too. It’s pretty obvious that the site run by transphobes that are trying VERY hard to look like they have legitimate medical concerns. I mean, one of the members listed on their own website is an editor at (the very right wing) Quillette, you know the one that regularly posts articles in support of things like race science. With articles to his name such as “JK Rowling Is Right—Sex Is Real and It Is Not a “Spectrum”” and “Think Cancel Culture Doesn’t Exist? My Own ‘Lived Experience’ Says Otherwise”
Others have published articles on Quillette like Macus Evans “Why I Resigned from Tavistock: Trans-Identified Children Need Therapy, Not Just ‘Affirmation’ and Drugs”
Another, William Malone, has articles published on 4thwavenow, a site who’s entire existence is centered on promoting transphobia, oh, and he’s published on Quillette too. I mean these were just the first three people I googled and they ALL had articles on Quillette, that seems incredibly suspect.
I’m imagining I wouldn’t find anything better under the other people’s names, and even their own website only claims they have 100 members, which is basically nothing. These people have entire carriers built around promoting transphobia, What SEGM is doing here is no different than when creationists get together and put together an org that claims to just be investigating questions about evolution, and to pretend
“SEGM is free from political, ideological, religious, or financial influences.” is a line found at the end of their about us page, but the first three people I googled were all members of far right organizations and promote far right politics. Excuse me if I don’t take your shitty sources seriously.
Hi Harper, I am not sure if your response is a parody or not, but I shall reply with a straight bat as there are indeed people out there that make arguments like yours.
I am not sure where you get the idea the site is ‘transphobic’ from. You give no examples. And I am quite sure you will not find any. You appear to think you can dismiss it using guilt by association because someone wrote something on a web site you do not like that said sex is real and not a spectrum. The idea that ‘sex is a spectrum’ is just a silly internet meme that ha got rather carried away. Of course sex is a strict dichotomy and not a spectrum – no peer reviewed biology paper has ever said otherwise. Only crank sociologists, bloggers and zany English Literature academics write stuff like that.
“Far right”. I think you may have lost all perspective.
Anyway, I linked to SEGM as they give very good, plain English language summaries of various evidence reviews. I could have cited the original Swedish and French if you prefer. My comment was about how these national scientific and medical bodies have come to very different conclusions to RW. If you wanted to counter my point, you would have to actually look at this evidence and decide if the national academies were “nazis” – or whatever you kids call people who disagree with you.
The question remains: why doe these national bodies, who do evidence reviews, come to very different conclusions to RW? What has she seen that they have not?
PS Nathankw’s comment gives a good idea of the answer here: RW blatantly misrepresented her sources.
Pretending that SEGM isn’t what it plainly is, and that the primary authors of the site don’t have a LONG history of transphobic remarks, makes it clear you don’t give a shit about “misrepresenting sources”
I’m trans and I’m also 44 years old, so if you think I’ve give this “kid” gives the slightest shit about your transphobic opinions, or has any desire to have an extended debate with some stranger on the internet about my right to exist prepare to be disappointed.
You give no evidence that SEGM has a “transphobic” stance except for guilt by association. You fail to provide any critique of its evidence summaries. So we can dismiss this stance as nonsense until you do.
And you refuse to address the substantive point that academies and authorities in (at least) France, Sweden and the UK believe the evidence base for puberty blockers is very shaky and should only be used on children with dysphoria in exceptional circumstances. This is at stark odds with Rebecca Watson’s conclusions.
You have also not addressed @nathankw123’s remarks that RW has cited the wrong sections of the evidence review she relies on, and ignored the pertinent sections that contradict her.
We can therefore dismiss you perhaps as being somewhat vested here in your denialist position.
This is nonsense. It’s in the goddamn namn. It’s entire purpose is to push a specific gender ideology. Quite frankly Harper, there’s no point in arguing with this kind of asshat.
https://www.buzzfeednews.com/article/avivastahl/transgender-trans-kids-healthcare-science
Josh – SEGM are reporting the findings of reviews conducted by various national academies and medical authorities. You are attacking the messenger rather than the message. Why does RWs analysis differ from these national academies?
I regret to inform you that anyone who is willing to post articles from SEGM to criticize therapy for trans children isn’t the kind of person who will be swayed by evidence that SEGM is transphobic. They’ve already ignored the vast amount of evidence in front of their face. “Hey now, this website may host a few people who have fought in court to reject the rights of human beings because they find trans people icky or whatever, but that shouldn’t imply anything about the site in general!” Riiiight.
Hi Scott – what is it on the SEGM site that led you to your firm conclusion that it is ‘transphobic’?
I am more than open to any actual evidence of this. But so far, no-one has been able to say why they have come to this conclusion.
And while you are here Scott, can you actually address the point that Swedish, French and British Academies and Authorities come to radically different conslcusions about the evidence base for puberty blockers than RW?
“I am more than open to any actual evidence of this. ”
Nice attempt at sealioning. It’s pretty obvious you are NOT open to any actual evidence of this though.
If you can’t see why hosting articles with titles denying the fundamental nature of sex and gender, thus implying that trans people don’t exist (otherwise known as, stay with me here, transphobia) makes your site by definition transphobic, I can’t help you. That’s like saying a site that hosts and promotes obviously misogynistic material isn’t itself misogynistic, or that a site that hosts obvious racist content (coughQuillettecough) isn’t racist. I guess they’re “just asking questions” like certain trolls that are hooting on Twitter about their impending banning, which certainly raises your credibility. Some of us have standards.
As for your insistence that caution on the part of several national agencies regarding puberty blockers is evidence that they are not safe, I will simply point to the tendency of agencies of this type to use an overabundance of caution, even when evidence does not warrant it. See: banning GMO’s for no good reason. People, even well-qualified people, make mistakes because of fear. I will let Rebecca speak to any perceived contradiction; I don’t have time to play with sea lions any more.
Scott – all of the peer reviewed biology says sex is a dichotomy based on the two distinct gamete types. The idea that it is a spectrum is a batshit idea that misused ideas of sex characteristic variation and development disorders to bamboozle people into thinking it is a “spectrum”. This is not an idea from the biological sciences but from crank humanities academics. You are not making a strong case against SEGM here.
It is also clearly transparent that you are using this ad hom to deflect from the very obvious fact that you cannot actually address the substantive criticisms of this blog post. This is a very poor reflection on ‘scepticism’ – resorting to the fallacies of homeopaths.
Pretty sure after calling people who disagree with you “cranks” you don’t get to play the ad hominem card.
Harper – how do you know I am not open to evidence of the site’s transphobia? You have not given any yet! Try me!
This was intended to be a response to Harper, btw, I don’t care what you think, Black Duck. A quick Google search reveals your quite obvious biases. And in case you think my viewpoint is “somewhat vested”, I am a straight cis male. I really have no dog in this hunt, except for my disgust for those who deny the existence of their fellow human beings.
And Scott – you appear incapable of addressing the points of evidence.
Two serious concerns have been raised here:
1) Academies in Europe flatly contradict RW.
2) RW has misrepresented the evidence base by ignoring the pertinent section of the review she relies on and quoting from another section. That seriously misleads her readers.
Can you actually address these issues?
Oh for sure. He doesn’t see the transphobia on SEGM because he shares their transphobic views. There is no point in engaging with people who think Quillette isn’t right wing nonsense. Anyone who thinks the “intellectual dark web” is a group of actual intellectuals instead of what happens when you give the worst members of humanity an unearned platform, isn’t worth the time.
Harper – when you present some evidence for transphobia on the SEGM site I will gladly engage with it.
I am wondering why you ignore the substantive point of my post though.
You don’t see the transphobia because YOU are also transphobic, so I don’t see what the point if such a debate would be. You would just deny that that said transphobia is actually transphobic, because you think you know better than the trans person you are speaking too, because people like you ALWAYS think you know better than minorities when we describe our experiences.
You cannot substantiate your claim that SEGM is “transphobic”. To do so you would have to show where on the site their analysis was motivated by an irrational fear or hatred of transpeople. It would even help if you could show where on the site their analysis is incorrect or mistaken. But you cannot even do that.
You have merely built irrational defences to prevent you engaging with ideas and evidence that would challenge deeply held and unshakable convictions you have about yourself.
“You have merely built irrational defences to prevent you engaging with ideas and evidence that would challenge deeply held and unshakable convictions you have about yourself.
Hahahah, oh my god if that isn’t the pot calling the kettle black.
I’m sorry but this blog dangerously misrepresents the evidence on puberty blockers. You rely on the Hormone Research in Paediatrics review ( https://www.karger.com/Article/FullText/501336 ) quoting from section 5 which says PBs are reversible and don’t impair fertility. But this section is talking about using PBs to treat precocious puberty.
Whilst it may well be true that the direct effect of the hormones themselves are reversible (ie when you stop taking them, puberty then restarts). The question is whether delaying puberty – beyond the crucial period when profound bodily changes would normally occur – itself has long term effects. That’s a completely different question from the effects of PBs when used for precocious puberty to prevent puberty from happening too early.
It’s like using evidence that insulin in safe in people with type 2 diabetes to show that insulin is safe for people without diabetes (when it can in fact kill).
Fortunately the paper you quote separates these two out. Section 5 deals with PBs in precocious puberty and, as you say, is very reassuring. As far as I can see, all your quotes are from this section.
The section on PB that IS actually relevant is Section 7: “Use of GnRHa in the Management of Transgender Adolescents”
This is what that section says:
“The impact on BMD (bone mass density) is concerning” and “The effects of GnRHa on adolescent brain maturation are unclear.” and on fertility ” GnRHa therapy prevents maturation of primary oocytes and spermatogonia and may preclude gamete maturation. Currently there are no proven methods to preserve fertility in early pubertal transgender adolescents.”
I urge readers to look at the full section. It’s short – only 2 paragraphs – showing the grave lack of evidence on this vital question.
What I don’t understand is that you must have read those lines – they’re in the same paper you quotes from.
Can you explain why you quoted sections that don’t even refer to the use of PBs for trans children yet didn’t quote the (deeply worrying) sections that specifically do consider trans children?
How can you reconcile the conclusion of that review which you held up as the best evidence: “it is unclear how long GnRHa can safely be administered” with your conclusion “The science on this is crystal clear”
There is simply no way both can be true.
What is skepticism for if it’s not about looking at what the evidence says, not what we wish it said?
I’d just like to add that “totally not transphobic” people like le canard noir are the exact reason that minorities like trans people mostly stay away from the “skeptic” community these days. I left right wing religious groups because of their mistreatment only to find out that skeptic and atheist groups were no more welcoming to us than a Baptist church.
I am sorry if I have made you feel ‘unwelcome”. I did not know when I first replied to you that you have adopted a social trans identity. I thought you were just making extremely daft arguments. My apologies.
Good lord, I don’t want your apology. I don’t accept it. Particularly when you follow it up with transphobic language like this.
“social trans identity”
Also I told you I was trans so it’s not my fault you weren’t bothering to read…now please leave me alone. I do not want to speak with you anymore. Nothing are you are going to say is going to make me like you or want to debate this topic with you.
Can we concentrate on the science rather than the personal attacks?
Harper and Scott – I’d be really interested to hear your thoughts on why Rebecca chose not to quote from the section of the review specifically about trans teens?
Obviously I’d like to hear directly from Rebecca how she’d respond to my points but sadly she doesn’t seem to be engaging.
I’m not interested in debating my very existence with strangers on the internet. Sorry, but I don’t exist to sate your curiosity., and honestly expecting civility from me after all the personal attacks levied…well I don’t really care what you expect or want.
I’ve not asked you to debate your existence (I 100% agree you exist!)
The blog is entitled “What the Science Says About Trans Teens on Puberty Blockers” – that’s the issue I’ve engage with, not anyone’s existence.
Nor have I levied any personal attacks on you or anyone else.
I am critical of Rebecca’s piece because I believe it is fundamentally misleading but the issue should be the content, not the writer.
It’s revealing that neither you, nor her, or anyone else has tried to defend what she wrote.
“I’ve not asked you to debate your existence (I 100% agree you exist!)”
That’s not what I mean and you know it. It’s this kind of weird and intentional refusal to understand what trans people mean when we say things that makes me think such a conversation would be a waste of my time.
I’m sorry if I’ve misunderstood – but I honestly don’t know in what way I’ve asked you to debate your existence.
Please reread my post – it’s concerned solely with the evidence for the safety of puberty blockers.
There’s no intentional refusal to understand: I really do want to understand your point of view.
So please explain in what way I’ve debated your existence?
Also it’s not within my abilities defend what she wrote in the sense you’ve demanded as I’m not privy to her internal thought processes, I have no idea why she chose to include certain things and not others, it’s bizarre you’d even ask me too.
I know that trans people exist, and that all those people (including me) started out as children, so obviously providing us access to medical care as soon as posible is going to be a good thing for us. Beyond that I’m not interested in debating the minutia of the medical standards because neither of us have the appropriate training to do so, and your position as a presumably cis person makes you doubly unqualified.
You might think you are just asking questions, but as we can see with the website the other guy choose to reference often people claim to just want to debate the science when they are just hiding their real motives to limit the rights of trans people and our access to medical care so you’ll understand why I’m not really amenable to wasting my time in such debates only to have it become clear down the line that said person was never really interested in real answers.
“There’s no intentional refusal to understand: I really do want to understand your point of view.
So please explain in what way I’ve debated your existence?”
Okay, I’m going to give you exactly ONE chance to prove you are not pulling the same sealioning BS that the other guy was pulling and answer this question. See if you can follow this logic.
This debate is fundamentally about whether or not we should deny or make it harder for trans people to access transition care. It’s often tied to the notion that being trans isn’t a “real” thing. Like maybe it’s framed as a mental illness or a choice, as the other guy did.
When you ask trans people to defend the idea that trans healthcare should be available the implication (whether you mean it to be or not) is to question whether or not we (or anyone for that matter) is actually trans. I.E. you are expecting me to defend the very notion that a fundamental part of my being is a real thing. I.E. debating my existence. THIS is what trans people mean when they say this.
Harper – when discussing puberty blockers for children, we just want to know what medical and clinical outcome you want such treatment to achieve and how you would measure effectiveness? We also want to know what risks and harms you would also take into account and balance against that measured clinical outcome.
if you can just describe coherently the medical justification then that would be a great start.
If it is not a clinical decision and it is a cosmetic decision, then you need to explain how a child can consent to that in great detail.
I think you’ve hit the nail on the head with the comment “so obviously providing us access to medical care as soon as possible is going to be a good thing for us.”
Well, only if it’s the right medical care.
Of course trans children need access to the very best medical care (as do all children). I’m certainly not questioning that.
I’m questioning WHAT the best medical intervention is? That’s a question only the scientific evidence can answer.
Anyone who genuinely wants trans children to receive the right treatment should be supporting the objective analysis of the very best evidence – because that’s the only way to make sure the treatment given is helping not harming children.
That’s all I’m asking for.
And as the evidence I’ve provided shows, Rebecca is not properly analyzing the science.
Honestly – read section 7 of the review Rebecca links to. It’s very short and very revealing.
It is so hard to make sense of this incoherent position which suggests being trans is not a medical condition and yet children who say they are trans absolutely require significant and life-altering medical treatments.
Having serious psychiatric distress is a medical condition. And the medical profession should be treating it. But we have no clear rationale for thinking puberty blockers are a meaningful treatment for this distress or if they work to alleviate it. The best evidence suggests they actually lock the distress in whereas minimal intervention allows these adolescent feelings to subside.
It is all so odd.
“Anyone who genuinely wants trans children to receive the right treatment should be supporting the objective analysis of the very best evidence”
The problem here is that trans people are not just some idea you can experiment on. We are real people with actual opinions on what we need and what will help us. Yet we find over and over that the “science” is often done and discussed by cis people who don’t really know anything about us, and refuse to learn or listen when we speak.
And this isn’t a new thing, science has a history of this. Pathologizing queer people and then paternalistically decided what is best for us and then doing that to us despite our protestations. If you think transition care is wrong, if you think access to blockers and HRT is wrong you are not following the evidence, because one form of evidence would be to listen to trans people TELL you what we need.
So, that is fair enough. We should listen to people with gender dysphoria.
So, what clinical outcome do you want to achieve when young people turn to psychiatrists with serious distress about their maturing sex and sexuality such that they come to believe they are not the sex they are?
Good god. I told you I did not want to speak with you anymore. What is so fucking hard about that?
That is a shame, as you made it quite clear we should be listening to your needs. And I am happy to do so.
But when I ask what the clinical needs of a child are who may be seeking puberty blockers you get all angry.
I’m out. I’ve told that other piecer of shit I don’t want to talk to him and he won’t leave me alone, since there is no block function here for my own mental health I’m leaving so I won’t see any of your responses.
That’s a pity as I thought we were getting somewhere.
FWIW I agree with you that there are people (and the Texas Governor appears to be one of them) who are ideologically opposed to trans children receiving any care. I’m happy to condemn that attitude.
I want something very different, for trans children to receive whatever care and treatment that will enable them to live the happiest most fulfilling life.
Where I disagree with you is on the process and where science fits in.
You say “trans people are not just some idea you can experiment on.”
No, they real people and using puberty blockers on children IS experimenting on them.
When used on trans children this is an unlicensed and experimental treatment with very little evidence on the effects.
Of course, all treatments start off as experimental. So what we need to do is proceed cautiously, collecting as much high quality data as possible and be guided by the science.
What we don’t need is for trans children to be treated as political footballs by the two sides of the ideological debate.
You say ” if you think access to blockers and HRT is wrong you are not following the evidence, because one form of evidence would be to listen to trans people TELL you what we need.”
But this is wrong. Of course we should always listen to patients about their lived experiences, wants and needs.
But the question of what the best treatment is can only be answered by science.
To take an analogy with homeopathy, a topic that Rebecca ( https://www.youtube.com/watch?v=5g_VpAzt7ac ) and I have both published on.
Many people say they want homeopathic treatment, indeed many people say they were cured by homeopathic treatment.
But to find out if it works (spoiler: it doesn’t) you can only get the answer by doing proper trials.
That’s the problem. It may seem to be kind just to give people the treatment they ask for. But people can only make the right decision, the one that will bring them long term health and happiness, if they have the correct information.
So blogs like this one may seem to be being kind, but by misrepresenting the science they risk hurting the very people they’re trying to help.
One last thing, you say the I’m unqualified. Like Rebecca I’ve spent my life understanding and explaining complex science so I’m at least as qualified as she it. But crucially I’m not asking anyone to take my word for it.
Read the review Rebecca pointed to as the best evidence. Read section 7. Ask yourself why Rebecca didn’t mention any of that directly relevant information. Then I think you’ll understand what I’m saying.
All the best,
N