Cass Report into Gender Identify Services - myths debunked

[Tristan]

Positive news with the NHS setting up 6 new gender identity regional centres over the next two years. https://www.bbc.co.uk/news/articles/cjrd3yylylro

[IvanV]

Withholding puberty blockers from gender dysphoric teenagers increases the risk of suicide substantially.

I think you missed this topic, which reported the news that a government-appointed expert debunked this claim? viewtopic.php?f=10&t=4272

It's such a toxic area it is hard to know who to believe, and "government-appointed" is not a neutral designation in the present circumstances. But flicking through their report, it was at least quite clear that the claim of increased suicides was anecdata from a small number of data points, not an analysis. Though with the Tavistock shutting down any comment on the issue, it was easy to believe a cover-up was going on. An analysis of the actual data found no such effect. But statistics is tricky stuff, so a peer review would be advisable. At the moment, being unaware of a debunking of this debunking, or credible claim that it is a cover-up, I'm inclined to think this is the best available evidence on this topic, until someone points me elsewhere.

The basic criterion ought to be "first, do no harm", especially in this area of limited evidence. Suicide risk is only one kind of harm. The BBC TV programme on Tavistock Clinic/GIDS this iplayer link I think, seemed to indicate some other kinds of potential harm from puberty blockers when used for gender dysphoria, for example that there could be some loss of fertility. But searching for evidence on this repeatedly confirms that when used properly and not for too long, and without confounding issues, there is very low risk of any such downsides.

So for me, it increasingly looks like allowing the puberty blockers is the nearer approximation to the "first, do no harm" approach on present evidence, even though it appears that the suicide risk claim was not well founded. Though you still then have to make good decisions in the time window that gives you. If you can't do that, then there's not much point to it. And, as I said before, even Cass didn't go so far as to recommend a ban on puberty blockers for gender dysphoria until there is better evidence, though what she did say wasn't so far short of that. Cass is being attacked from both sides. This topic started with attacks from the right for not going far enough. Now it is being attacked from the other side for going too far. One thing that BMA says is sensible, Cass could do with a peer review. But it is very difficult finding well-informed people who don't already have a particular stance on these matters to do that in an objective way.

The BBC programme I mentioned above had an interview with a woman who had detransitioned after a double mastectomy. She was understandably very bitter about the treatment she got from the Tavistock clinic. She also the fact that they cease supporting you once you detransition, when in fact you need a lot of support at that point. That was exceedingly distressing to watch. This was placed alongside a very happy subject who was very happy with their transition. It seems to be hard to get any good statistics on frequency of the two kinds of outcome. In any area of medicine there are mistakes. Ideally we avoid the former kind of mistake. But we have to choose the option that produces the best overall outcome, recognising that there might be some mistakes.

On Monday, I shall have an operation on my left eye. It might do no good, in which case I shall go through a lot of suffering for nothing. In rare cases, it can do harm. But the operation is indicated because on balance it is the best thing to do with that particular condition in the eye. A decision perfectly separating good from harm is unavailable, we can only go with the balance of advantage. We need to remember that.

[dyqik]

Withholding puberty blockers from gender dysphoric teenagers increases the risk of suicide substantially.

I think you missed this topic, which reported the news that a government-appointed expert debunked this claim? viewtopic.php?f=10&t=4272

No, I had not missed it.

Given that the government is not to be trusted on this subject, having instigated a highly biased review, I will stick to Bayesian priors on the subject, which is that gender dysphyoria makes teenagers not feel good about themselves in many ways. Which is likely to increase the risk of suicide.

What I won't do is declare that we don't have hard data, therefore there's no harm in leaving gender dysphoria untreated. Choosing to leave gender dysphoria untreated rather than following established treatments is choosing to do potential harm.

[Tristan]

Nobody’s saying gender dysphoria shouldn’t be treated. These new centres are going to be treating it, but in a more holistic way.

[Tristan]

On Monday, I shall have an operation on my left eye. It might do no good, in which case I shall go through a lot of suffering for nothing. In rare cases, it can do harm. But the operation is indicated because on balance it is the best thing to do with that particular condition in the eye. A decision perfectly separating good from harm is unavailable, we can only go with the balance of advantage. We need to remember that.

Does the doctor definitely know what’s wrong with your eye? Is there only one possible cause of the issue for which the operation is the only possible treatment?

That’s at the heart of what the issue with PBs that pretty much inevitably lead to hormones has been I think. That’s why these new centres that explore multiple potential issues will help.

[dyqik]

Nobody’s saying gender dysphoria shouldn’t be treated. These new centres are going to be treating it, but in a more holistic way.

I don't see how banning one of the treatments is "more holistic". It's always opposite land in this subject.

That’s at the heart of what the issue with PBs that pretty much inevitably lead to hormones has been I think. That’s why these new centres that explore multiple potential issues will help

The point of puberty blockers is to give time for all avenues to be explored.

[Tristan]

The point of puberty blockers is to give time for all avenues to be explored.

Except that just isn’t what was happening.

But I’m sure your Bayesian priors know better.

[dyqik]

The point of puberty blockers is to give time for all avenues to be explored.

Except that just isn’t what was happening.

Even if that wasn't what was happening, then banning puberty blockers still removes the option of taking more time to explore.

[Tristan]

There’s a trial happening, which is what should have happened from the start. Depending on what the outcome of that is PB’s may indeed come back in a properly regulated way.

Meanwhile a couple of former GIDS staff who denounced Cass turn out to be making stuff up about her.

https://x.com/benryanwriter/status/1821 ... iksLglQFYQ

[IvanV]

The point of puberty blockers is to give time for all avenues to be explored.

Except that just isn’t what was happening.

I haven't read the material well enough to understand whether the puberty blockers were being routinely misused to then railroad people into transitioning right or wrong, or whether that just happened in some cases. But that it did happen at least sometimes has been exposed, and Tavistock has closed. It seems unlikely that railroading would now carry on.

The problem of banning them is that it closes off options that there may be time for, for some subjects. There seems to be good enough evidence that they can be used benignly. So that makes the ban look wrong.

On the other hand, if there is still currently no scope to use them properly, then prescribing them just gives false hopes.

I don't know what the balance is between these two possibilities. The Tories who brought in the ban seemed quite clearly to be doing it to look socially conservative, right or wrong. If Labour is prolonging the ban, is that because they want to look very socially conservative too, or is it because there is actually a respectable reason for it?

Meanwhile about 1000 senior doctors sign a letter (BBC) objecting to the BMA's recent stance on this. Apparently that included Phil Hammond, the Private Eye medical correspondent. This is the text of the letter. It asserts that:

The Cass Review is the most comprehensive review into healthcare for children with gender related distress ever conducted. It took 4 years to complete and commissioned 7 systematic reviews from the University of York. It recommended a new approach based on safe, holistic, evidence-based care. It has thirty-two recommendations to improve and extend clinical services for this vulnerable group, with ongoing and embedded audit and research.

But it seems that some people don't think that is quite the truth. Some of the objectors to Cass, from both directions, clearly have an axe to grind. Whether the leadership of the BMA, who think that Cass needs looking at, have an axe to grind, or good grounds to think that what is said there isn't quite the truth, I remain confused. It may be irrelevant, but personally I don't think it is a good look that there was encouragement to sign the letter on Mumsnet.