Texas government now actively terrorizing families of trans kids

[Jarhyn]

My take on this:

It is very disappointing that trans activists are so strongly in favor of specific treatments that lack sound scientific evidence, acting as if it is settled science and terrorism/homicide to deny such treatments. This approach is backfiring as credibility and trust is completely eroded due to where the medical community is actually at in regards to the science.

This letter is a good overview of the concerns many in the medical community have over the use of puberty blockers for transgender youth:

---

Puberty blockers for gender dysphoric youth: A lack of sound science​

...
Received: 6 June 2022 Accepted: 7 June 2022 DOI: 10.1002/jac5.1691
LETTER TO THE EDITOR

---

Puberty blockers for gender dysphoric youth: A lack of sound science​

Dear Editor,
The medical transition of children and adolescents with gender dysphoria remains highly debated and there is significant divergence in policy internationally.1-7 Mills and colleagues' review the interventions that comprise the “gender-affirmative” care pathway, an approach currently promoted by many medical organizations in North America.6-8 We strongly agree with the authors that pharmacists have a responsibility to “understand the evidence,” and “place the well-being of the patient over any personal cultural beliefs.”8 However, we think the use of evidence to support the authors' claim that gonadotropin releasing hormone (GnRH)-analogs are fully reversible and have been shown to improve mental health, requires critical appraisal.
GnRH-analogs have been used for decades to successfully delay the early onset of puberty in children with precocious puberty.9 While generally considered safe for this indication, recent concern about impacts on polycystic ovarian disease, metabolic syndrome, and future bone density, have been raised.10 Even less is known about the use of GnRH-analogs to halt normally timed puberty in youth with gender dysphoria; no long-term, longitudinal studies of GnRH-analogs for this indication exist.
Puberty-related hormones have wide ranging effects on brain structure, function, and connectivity.11 Concerns have been raised that hormonal suppression of puberty may permanently alter neurodevelopment.2,11-13 The possible impact of puberty blockade on a young person's cognition has important implications for the decision to initiate exogenous cross-sex hormones and the capacity to give informed consent.14 Moreover, it has been suggested that pubertal suppression may alter the course of gender identity development, essentially “locking in” a gender identity that may have reconciled with biological sex during the natural course of puberty.13 Over 95% of youth treated with GnRH-analogs go on to receive cross-sex hormones.15 By contrast, 61-98% of those managed with psychological support alone reconcile their gender identity with their biological sex during puberty.16-18 This lack of evidence to support the durability of a transgender identification is conceptually consistent with significant psychosocial determinants of cross-sex identity, while the belief in immutable biological influences can best be described as a “current hypothesis.”19
There are also concerns that GnRH-analogs may have irreversible effects on sexual function and bone development. In some youth pubertal blockade at Tanner stage 2 followed by exogenous cross-sex hormones has resulted in a complete absence of adult sexual function.20 Profound effects on future sexual function may even occur when puberty is paused and later allowed to proceed, since the precise timing of hormone exposure during the peripubertal window is a determinative factor in adult sexual function.21 Finally, several studies have found that the expected pattern of bone mass accrual during adolescence does not occur when puberty is halted.22-25 The longterm clinical consequences of failure to accrue normal bone mass are unknown.
Uncertainties about long-term risks of medical transition are often overshadowed by the most potent argument provided by advocates of the affirmative model: failure to affirm a young person's transgender identity may result in suicide. Suicidal ideation and self-harming behaviors have been found to be higher than age-matched peers, but comparable to nongender dysphoric youth referred for management of other mental health diagnoses.26 However, the relevant question is whether affirmative care reduces suicide risk. Mills and colleagues assertion that GnRH-analogs have been shown to decrease lifetime suicidal ideation stems from a nonrepresentative, low-quality survey of transgender adults that has been thoroughly critiqued by others.27,28 Moreover, their claim that these drugs are effective for other mental health outcomes is at odds with recent systematic reviews that concluded there is little change from baseline to follow-up in depression, anxiety, body image, gender dysphoria, or psychosocial functioning.2,12,29 A seminal Dutch case-series of children with early-onset gender dysphoria is cited to support the assertion that GnRH-analogs improve psychological functioning.15 The magnitude of posttreatment improvement in mental health outcomes in this study was small and of questionable clinical significance. Furthermore, the applicability of results to the most common demographic presenting today, that is, adolescent females with preexisting mental health problems or neurodevelopmental conditions and no prior history of gender dysphoria, is questionable.4,30 A recent attempt to replicate the results of the Dutch study in the United Kingdom found no psychological benefit with GnRH-analogs, but treatment was associated with adverse effects on bone development.31
Multiple European countries that were pioneers in youth medical transition are now adopting a more cautious approach to the use of
GnRH-analogs and cross-sex hormones after their own evidence reviews failed to show mental health benefits and highlighted a profound lack of knowledge about harms. The UK's Cass review emphasized the paucity of data in their interim report stating, “it is important that it is not assumed that outcomes for, and side effects in, children treated for precocious puberty will necessarily be the same in children or young people with gender dysphoria.”13 The NHS updated guidance on treatment of gender dysphoria removed statements about the reversibility of GnRH-analogs and now states, “little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.”4 The Swedish Health Authority no longer offers GnRH-analogs to minors except in exceptional cases stating, “the risks of puberty suppressing treatment with GnRHanalogues and gender affirming hormonal treatment currently outweigh the possible benefits.”3 Finland has severely restricted their use and now recommend psychotherapy as first-line treatment for gender-dysphoric youth.2 Lastly, the French Académie Nationale de Médecine recently issued a press release stating, “great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.”5 Although puberty-blockers and cross-sex hormones will still be available, the Académie emphasized, “the greatest reserve is required in their use, given side effects such as impact on growth, bone fragility, risk of sterility, emotional and intellectual consequences and, for girls, symptoms reminiscent of menopause.”5

https://accpjournals.onlinelibrary....?domain=p2p_domain&token=VMDIIBB55ARIBCZCTEFE

That being said, it seems pretty insane for state houses to be passing bans on these things. They certainly are not going to make a good decision, being guided by politics and culture wars than science. Setting up an independent commission of top medical professionals in this area to release recommendations and best practices I can support.

I can't help but think that the long term effects of puberty blockade are one of the oldest set of prognoses that have been recorded among all of human history, because more people have blocked puberty since before recorded history through castration, both self-initiated and externally forced.

The neurological developments during puberty are, from this perspective, completely unnecessary to fully actualized adult behavior.

We know full well what happens when someone grows up as a eunuch. They become a eunuch. Eunuchs are well understood throughout history and are clearly capable of being fully actualized adults. The Chinese government was literally run by eunuchs for thousands of years.

I could see this if there was no history of humans observing the effect of humans deprived of sex hormones, but there is DEEP history of it

 

[Axulus]

My take on this:

It is very disappointing that trans activists are so strongly in favor of specific treatments that lack sound scientific evidence, acting as if it is settled science and terrorism/homicide to deny such treatments. This approach is backfiring as credibility and trust is completely eroded due to where the medical community is actually at in regards to the science.

This letter is a good overview of the concerns many in the medical community have over the use of puberty blockers for transgender youth:

---

Puberty blockers for gender dysphoric youth: A lack of sound science​

...
Received: 6 June 2022 Accepted: 7 June 2022 DOI: 10.1002/jac5.1691
LETTER TO THE EDITOR

---

Puberty blockers for gender dysphoric youth: A lack of sound science​

Dear Editor,
The medical transition of children and adolescents with gender dysphoria remains highly debated and there is significant divergence in policy internationally.1-7 Mills and colleagues' review the interventions that comprise the “gender-affirmative” care pathway, an approach currently promoted by many medical organizations in North America.6-8 We strongly agree with the authors that pharmacists have a responsibility to “understand the evidence,” and “place the well-being of the patient over any personal cultural beliefs.”8 However, we think the use of evidence to support the authors' claim that gonadotropin releasing hormone (GnRH)-analogs are fully reversible and have been shown to improve mental health, requires critical appraisal.
GnRH-analogs have been used for decades to successfully delay the early onset of puberty in children with precocious puberty.9 While generally considered safe for this indication, recent concern about impacts on polycystic ovarian disease, metabolic syndrome, and future bone density, have been raised.10 Even less is known about the use of GnRH-analogs to halt normally timed puberty in youth with gender dysphoria; no long-term, longitudinal studies of GnRH-analogs for this indication exist.
Puberty-related hormones have wide ranging effects on brain structure, function, and connectivity.11 Concerns have been raised that hormonal suppression of puberty may permanently alter neurodevelopment.2,11-13 The possible impact of puberty blockade on a young person's cognition has important implications for the decision to initiate exogenous cross-sex hormones and the capacity to give informed consent.14 Moreover, it has been suggested that pubertal suppression may alter the course of gender identity development, essentially “locking in” a gender identity that may have reconciled with biological sex during the natural course of puberty.13 Over 95% of youth treated with GnRH-analogs go on to receive cross-sex hormones.15 By contrast, 61-98% of those managed with psychological support alone reconcile their gender identity with their biological sex during puberty.16-18 This lack of evidence to support the durability of a transgender identification is conceptually consistent with significant psychosocial determinants of cross-sex identity, while the belief in immutable biological influences can best be described as a “current hypothesis.”19
There are also concerns that GnRH-analogs may have irreversible effects on sexual function and bone development. In some youth pubertal blockade at Tanner stage 2 followed by exogenous cross-sex hormones has resulted in a complete absence of adult sexual function.20 Profound effects on future sexual function may even occur when puberty is paused and later allowed to proceed, since the precise timing of hormone exposure during the peripubertal window is a determinative factor in adult sexual function.21 Finally, several studies have found that the expected pattern of bone mass accrual during adolescence does not occur when puberty is halted.22-25 The longterm clinical consequences of failure to accrue normal bone mass are unknown.
Uncertainties about long-term risks of medical transition are often overshadowed by the most potent argument provided by advocates of the affirmative model: failure to affirm a young person's transgender identity may result in suicide. Suicidal ideation and self-harming behaviors have been found to be higher than age-matched peers, but comparable to nongender dysphoric youth referred for management of other mental health diagnoses.26 However, the relevant question is whether affirmative care reduces suicide risk. Mills and colleagues assertion that GnRH-analogs have been shown to decrease lifetime suicidal ideation stems from a nonrepresentative, low-quality survey of transgender adults that has been thoroughly critiqued by others.27,28 Moreover, their claim that these drugs are effective for other mental health outcomes is at odds with recent systematic reviews that concluded there is little change from baseline to follow-up in depression, anxiety, body image, gender dysphoria, or psychosocial functioning.2,12,29 A seminal Dutch case-series of children with early-onset gender dysphoria is cited to support the assertion that GnRH-analogs improve psychological functioning.15 The magnitude of posttreatment improvement in mental health outcomes in this study was small and of questionable clinical significance. Furthermore, the applicability of results to the most common demographic presenting today, that is, adolescent females with preexisting mental health problems or neurodevelopmental conditions and no prior history of gender dysphoria, is questionable.4,30 A recent attempt to replicate the results of the Dutch study in the United Kingdom found no psychological benefit with GnRH-analogs, but treatment was associated with adverse effects on bone development.31
Multiple European countries that were pioneers in youth medical transition are now adopting a more cautious approach to the use of
GnRH-analogs and cross-sex hormones after their own evidence reviews failed to show mental health benefits and highlighted a profound lack of knowledge about harms. The UK's Cass review emphasized the paucity of data in their interim report stating, “it is important that it is not assumed that outcomes for, and side effects in, children treated for precocious puberty will necessarily be the same in children or young people with gender dysphoria.”13 The NHS updated guidance on treatment of gender dysphoria removed statements about the reversibility of GnRH-analogs and now states, “little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.”4 The Swedish Health Authority no longer offers GnRH-analogs to minors except in exceptional cases stating, “the risks of puberty suppressing treatment with GnRHanalogues and gender affirming hormonal treatment currently outweigh the possible benefits.”3 Finland has severely restricted their use and now recommend psychotherapy as first-line treatment for gender-dysphoric youth.2 Lastly, the French Académie Nationale de Médecine recently issued a press release stating, “great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.”5 Although puberty-blockers and cross-sex hormones will still be available, the Académie emphasized, “the greatest reserve is required in their use, given side effects such as impact on growth, bone fragility, risk of sterility, emotional and intellectual consequences and, for girls, symptoms reminiscent of menopause.”5

https://accpjournals.onlinelibrary....?domain=p2p_domain&token=VMDIIBB55ARIBCZCTEFE

That being said, it seems pretty insane for state houses to be passing bans on these things. They certainly are not going to make a good decision, being guided by politics and culture wars than science. Setting up an independent commission of top medical professionals in this area to release recommendations and best practices I can support.

I can't help but think that the long term effects of puberty blockade are one of the oldest set of prognoses that have been recorded among all of human history, because more people have blocked puberty since before recorded history through castration, both self-initiated and externally forced.

The neurological developments during puberty are, from this perspective, completely unnecessary to fully actualized adult behavior.

We know full well what happens when someone grows up as a eunuch. They become a eunuch. Eunuchs are well understood throughout history and are clearly capable of being fully actualized adults. The Chinese government was literally run by eunuchs for thousands of years.

I could see this if there was no history of humans observing the effect of humans deprived of sex hormones, but there is DEEP history of it

So if you know full well what happens, then what are the exact implications of GnRH-analogs for bone mass, adult sexual function, neural development, and polycystic ovarian disease? You are claiming we have these answers?

The whole claim I always hear from the trans activists is that puberty blockers are reversable, they just give more time to make a final decision. And yet the list of issues above are potentially permanent effects.

And what does the evidence suggest as to how durable a prepubescent transgender identity is post-puberty for those that took puberty blockers vs. those that didn't? Have there been any good randomized trials that provide data on this? If there is any difference then that would also be a permanent effect of the blockers.

On top of all this, the additional psychological benefit of administring them is being called into question by many reputible medical professionals based on full analysis of the literature, which is why we are seeing many countries no longer recommending them as a treatment until we have better evidence that the benefits exceed the risks.

 

[Jarhyn]

So if you know full well what happens, then what are the exact implications of GnRH-analogs for bone mass, adult sexual function, neural development, and polycystic ovarian disease?

Humanity does, as a species, among our medical documentation, k ow the exact implications of a complete absence of testicular function.

We also know, fairly succinctly, that people who wish to have their ovaries cease to function, that removal gives 100% relief to polycystic ovarian disease (as an absence of ovaries will accomplish just that).

Neural development we have a pretty good lock on seeing as that outcome is the same prognosis as historical castration, and we have plenty of examples of individuals who have this condition, although fewer than we ought due to overzealous "treatment" with artificial sex hormones for normalization purposes.

This is because the symptoms you describe are not symptoms of the GnRH analog but rather of the treatment itself, which is going to have a nearly 1:1 analog to castration.

As to "adult sexual function", I have yet to see a single piece of documentation even starting to imply that blockers "broke" that. For anyone. Something tells me that would be a huge concern, and a piece of immediate knowledge in the trans community. If it's merely about "organ development", the absence of "normal adult erections" and "normal adult penis size" would be straight up "shut up and take my money" territory for most trans women and eunuchs.

As has been explored, neurological development for humans who were castrated before puberty seems to be just fine seeing as how that described the majority of the Chinese government through antiquity.

Go ahead and seek continued research in these subjects, but don't pretend it's never been researched or that we have any shortage of information on that front.

If there were some side effects to the medication itself rather than the well researched effects of the absence of gonads, we would have been able to measure that from precocious puberty studies and treatments.

 

[Axulus]

So if you know full well what happens, then what are the exact implications of GnRH-analogs for bone mass, adult sexual function, neural development, and polycystic ovarian disease?

Humanity does, as a species, among our medical documentation, k ow the exact implications of a complete absence of testicular function.

Apples and oranges. We are talking specifically puberty blocker medications: differences in adulthood for taking them vs. not taking them.

We also know, fairly succinctly, that people who wish to have their ovaries cease to function, that removal gives 100% relief to polycystic ovarian disease (as an absence of ovaries will accomplish just that).

So? The question is whether the puberty blockers cause a difference in the risk of this condition.

Neural development we have a pretty good lock on seeing as that outcome is the same prognosis as historical castration, and we have plenty of examples of individuals who have this condition, although fewer than we ought due to overzealous "treatment" with artificial sex hormones for normalization purposes.

And what are those effects, precisely?

This is because the symptoms you describe are not symptoms of the GnRH analog but rather of the treatment itself, which is going to have a nearly 1:1 analog to castration.

What are you basing that on? Is it not possible GnRH has unintended negative side effects that differ from castration?

As to "adult sexual function", I have yet to see a single piece of documentation even starting to imply that blockers "broke" that. For anyone. Something tells me that would be a huge concern, and a piece of immediate knowledge in the trans community. If it's merely about "organ development", the absence of "normal adult erections" and "normal adult penis size" would be straight up "shut up and take my money" territory for most trans women and eunuchs.

The question is whether there are permanent effects into adulthood for those who were on them as a child. And one of the big issues is that prepubescent gender dysphoria and transgender identity is only durable in about 20% of cases post-puberty.

Evidence from the 10 available prospective follow-up studies from childhood to adolescence (reviewed in the study by Ristori and Steensma28) indicates that for ~80% of children who meet the criteria for GDC, the GD recedes with puberty.

https://www.ncbi.nlm.nih.gov/pmc/ar...e from the 10,desistance or persistence of GD.

As has been explored, neurological development for humans who were castrated before puberty seems to be just fine seeing as how that described the majority of the Chinese government through antiquity.

We have only had scientifically valid and rigorous medical research for little more than a hundred years, so of what relevance is what the Chinese government has said about the topic?

Go ahead and seek continued research in these subjects, but don't pretend it's never been researched or that we have any shortage of information on that front.

Yes, there is absolutely a shortage of scientifically rigorous logintudinal studies on the effects of puberty blockers perscribed to children. Which ones do you have in mind as top quality here? Can you post some?

If there were some side effects to the medication itself rather than the well researched effects of the absence of gonads, we would have been able to measure that from precocious puberty studies and treatments.

Which logintudinal ones are you referring to here? And there have been concerns. Take Lupron, as one example:

More than 10,000 adverse event reports filed with the FDA reflect the experiences of women who’ve taken Lupron. The reports describe everything from brittle bones to faulty joints.


In interviews and in online forums, women who took the drug as young girls or initiated a daughter’s treatment described harsh side effects that have been well-documented in adults.

Women who used Lupron a decade or more ago to delay puberty or grow taller described the short-term side effects listed on the pediatric label: pain at the injection site, mood swings, and headaches. Yet they also described conditions that usually affect people much later in life. A 20-year-old from South Carolina was diagnosed with osteopenia, a thinning of the bones, while a 25-year-old from Pennsylvania has osteoporosis and a cracked spine. A 26-year-old in Massachusetts needed a total hip replacement. A 25-year-old in Wisconsin, like Derricott, has chronic pain and degenerative disc disease.

“It just feels like I’m being punished for basically being experimented on when I was a child,” said Derricott, of Lawton, Okla. “I’d hate for a child to be put on Lupron, get to my age and go through the things I have been through.”

In the interviews with women who took Lupron to delay puberty or grow taller, most described depression and anxiety. Several recounted their struggles, or a daughter’s, with suicidal urges. One mother of a Lupron patient described seizures.

Such complaints have recently come under scrutiny at the FDA, which regulates drug safety.

https://www.statnews.com/2017/02/02/lupron-puberty-children-health-problems/

 

[Jarhyn]

Apples and oranges. We are talking specifically puberty blocker medications: differences in adulthood for taking them vs. not taking them

All the consequences you discussed have little to do with the specific medication and everything to do with the effects of treatment.

We are talking, principally, about the direct effect of the absence of certain hormones.

As it is there are various medications prescribed, and there is a long history of prescribing the medication to various age ranges for various reasons, all of which are fairly well documented with grown adults to associate with those cases.

The question is whether there are permanent effects into adulthood for those who were on them as a child

Of course there are. Among those effects are included "didn't grow breasts" and "voice deepened" and "shoulders grew broadly" and also "taller than peers of similar development".

These are all things that many people would gladly exchange for "osteoporosis risk".

What are you basing that on? Is it not possible GnRH has unintended negative side effects that differ from castration?

It's unlikely that it would have any significant side effects not observed in the cohorts who have been taking it, nor any of the adults who take testosterone blockers.

With Spiro there is some risk associated with low sodium.

~80% of children who meet the criteria for GDC, the GD recedes with puberty.

The end of the ‘desistance’ myth?

Read on for new (as yet unpublished) ‘desistance’ statistics from Australia (Spoiler: it may be as low as 4% ‘desistance’). The 85% ‘desistance’ myth Anyo…

growinguptransgender.com

We have only had scientifically valid and rigorous medical research for little more than a hundred years, so of what relevance is what the Chinese government has said about the topic?

The fact that for a thousand years, the premier way into government service in China was to be a eunuch.

Or were you ignorant of the fact that all across Asia before paper pushed west, eunuchs were the premier paper pushers?

The fact is that eunuchs were studying and recording the prognosis of terminated puberty since before modern medicine.

Plenty of discussion is available historically.

Now please quit quoting debunked bullshit that has already been debunked elsewhere on these forums just in the last month (WRT the desistance myth).

 

[Axulus]

Now please quit quoting debunked bullshit that has already been debunked elsewhere on these forums just in the last month (WRT the desistance myth).

I'm sorry, but this is complete bullshit. You can call these studies bad studies, and I agree they have definite flaws, but the point is they are the _only_ ones that have been done in the published literature. The science is unsettled here, which has been my point all along. I looked everywhere for a published study from that Australian statistic you cite and found nothing. It was stated in a family court proceeding and yet they have not published their data. Why is that given the game changing nature in the debate of such a finding? The quote came from 2017 and yet they can't be bothered to take it through the peer review process?

Here is another 2022 study that reviewed the available literature and has the same conclusion:

Results: One qualitative study, 2 case studies, 5 quantitative studies, 5 ethical discussions, and 22 editorials were assessed. Quantitative studies were all poor quality, with 83% of 251 participants reported as desisting. Thirty definitions of desistance were found, with four overarching trends: desistance as the disappearance of gender dysphoria (GD) after puberty, a change in gender identity from TGE to cisgender, the disappearance of distress, and the disappearance of the desire for medical intervention.
Conclusions: This review demonstrates the dearth of high-quality hypothesis-driven research that currently exists and suggests that desistance should no longer be used in clinical work or research. This transition can help future research move away from attempting to predict gender outcomes and instead focus on helping reduce distress from GD in TGE children.

https://scholar.google.com/scholar?hl=en&as_sdt=0,10&q=transgender+desistance&oq=transgender+desis#d=gs_qabs&t=1710832066497&u=#p=jAx0ufgYvRoJ

You have not linked to a single scientific paper since we have began engaging on this topic. You are just posting to blog advocacy links and bringing in a lot of anecdotal information. Now do you have something in the literature that is relevant here that demonstrates the data you seem to believe is true is actually scientifically grounded or not?

 

[Axulus]

I also think there is a bit of confusion on this topic, so let me state my position as clearly as possible.

We start with a group of prepubescent children diagnosed with gender dysphoria (GD)

The goal is to provide them with the best medical treatment available to reduce the stress resulting from their GD.

I think we can all agree that some sort of non-pharmaceutical therapy is almost certainly a good idea in nearly all cases and mostly non-controversial. Best medical practices should be used here that has been shown scientifically to have positive outcomes. Include the parents as well and help them to understand and accept their child as they are, etc.

This will work sufficiently for a subset of this group, let's call them group A. The stress from their GD is reduced sufficiently to where they go through puberty as normal. As an adult, some may decide to fully transition through HRT, surgery, and/or a combination of the two. Let's call this group, group B. Of this group B, some of them will be unhappy they were not given puberty blockers as a prepubscent as that would've allowed them to more effectively transition to the gender they identify with. Let's call this group C. On the plus side, they did avoid the potential unwanted harms from the puberty blockers, such as lower bone mass, or whatever other unintended negative consequences this trearment has, which I would argue is not fully known. However, there will also be a subset of group B, let's call them group D, that are not distressed or unhappy by the lack of puberty blockers as a child. Both group C and group D did not have any medical interventions done to them as a child that is irreversible as an informed adult.

Finally, of this group A, a subset of them will decide not to transition to the opposite sex. Let's call them group E. The "desisters". Their GD is either resolved or minor enough to where no HRT or surgery is desired.

Next, we gave a group, let's call it group F, where the non-pharmaceutical therapy options as a child provide insufficient reduction to the distress caused by their GD.

Of this group F, we will have a subset, call it group G, that does not get futher treatment as a child, either because the parents oppose it, the child decides not to go through with it, or the medical advice they receive does not recommend it. Of this group G, we will have a futher subset, group H, that decides to transition to the opposite sex as an adult, through a combination of HRT and surgery. This group is likely to be unhappy with the lack of puberty blockers as a child, as their transition will not be as effective as otherwise. They also had a childhood experiencing distress from their GD that may have been reduced with puberty blockers and HRT. But then again, for some cases, this may not of made a big difference either.

We also have another subset of group F, call them group I, that decides not to transition to the opposite sex as an adult. Their GD is either resolved or minor enough to where no HRT or surgery is desired. They will likely be happy they did not receive puberty blockers and HRT as a child as they would have undesired and irreversible effects from this treatment. However, they also remained with high distress as a child from their GD, which may have been reduced by these treatment methods.

Finally, we have the final subset of group F, call them group J. These are the ones whose distress from GD is not sufficiently reduced by non-pharmaceutical means, who then get treated with puberty blockers and also potentially HRT, and in some cases (usually 16+), surgical methods, all towards the goal of fully transitioning them to the opposite sex so that their distress from their GD may be sufficiently reduced.

Of this group, we have a subset, group K, who fully transition to the opposite sex as an adult. They are happy they had puberty blockers and HRT as a child as they can now more effectively transition as an adult. However, they may suffer from some undesired side effects from the puberty blockers and HRT received, such as reduced bone mass and potentially reduced sexual response and function. But, generally, the positives outweigh the negatives for this group.

And, lastly, we have another subset, group L, who received puberty blockers and HRT as a child but decides not to fully transition to the opposite sex as an adult. Either their GD is resolved or minor enough that they do not desire to proceed further in transitioning. Some members of group L will still have benefitted from puberty blockers and HRT, perhaps they suffer from minimal side effects of these treatments as an adult, and it also reduced the distress of their GD as a child.

However, some members of group L will suffer from undesired side effects, such as lower bone mass, reduced sexual function, etc. Additionally, since they choose not to transition, they may feel regret and unhappy about the puberty blockers they received as a child. They may also feel, rightly, that they were too young to give informed consent to their treatment received as a prepubscent child, and feel anger at what was done to them.

Sorry for the overly lengthy post, but my contention is that the percentage of individuals that would fall under any of these group categories, A-L, is not very well scientifically established. The long term benefits and harms caused by puberty blockers and HRT is also not sufficiently scientifically established.

The fundamental question at hand here, in regards to puberty blockers and HRT, is do the benefits to all these groups in question exceed the harms of this treatment in comparison to the lack of the treatment. And, in addition, what role does the lack of fully informed conscent play in our analysis, since we are talking about potentially permanent effects to a prepubscent child.

I'm very open to new data on this question. I think the most severe cases of childhood GD warrant a more drastic treatment attempt. However, we need much more research on the matter to make better informed decisions.

Right now, it seems like Europe mostly believes that there is a lack of scientifically rigorous benefit outweighing the cost of puberty blockers/HRT in children, and are no longer recommending it as a treatment for GD. What are we to make of this?

And let me just state: I don't think the answers to any of these questions should be resolved by politicians passing laws on the matter. In fact, that is probably the worst group in society to be doing that.

This needs to be resolved by the medical profession, with input from parents of children with GD, the children with GD, and also adults who had GD as children. These are the relevant stakeholders and should be the only ones involved with the decisions here.

 

[Axulus]

Something more on topic, and I hope we can all agree this is extremely vile:

Alabama Republicans target transgender Space Camp employee

Republican Rep. Dale Strong called for Space Camp to remove a transgender employee after a viral social media post called the person a “freak.”

https://www.google.com/amp/s/www.nbcnews.com/news/amp/rcna143094

IoW, MAGA wants to make it illegal to hire transgender individuals for some jobs solely based on them being transgender. Extremely sickening

 

[Jarhyn]

I'm sorry, but this is complete bullshit. You can call these studies bad studies, and I agree they have definite flaws, but the point is they are the _only_ ones that have been done in the published literature

Bad studies with bad data are bad studies with bad data even if they are the only studies you have. They are invalid particularly because they use bad data, and you can't reach the conclusions you try to.

Further, desistance rates of those who start HRT are, predictably, extremely low.

No, they are not acceptable science, they are junk, and 90% of the people from the study on examination were not even trans in the first place, but rather tomboyish girls and the like who directly expressed their gender identity to be female, and we're still assigned an evaluation of "GID". Other studies had FIVE or fewer participants, and a few of them counted dropouts as desisting.

No, they are not the "only". There are NO studies that actually support that conclusion, because those are not valid studies in the first place.



Now, I do think there is some failure happening in terms of trans kids, insofar as there is not enough open and pressure free discussion around the complexities of gender in the first place.

There are a number of elements going on in the psychological space, between the hormones, the body, and "gender", and I discussed this in my most recent post to the "feeling gender" thread.

First, there is the inter-relation between which actions lead to which emotional states. This is something immutable and connects the individual to feelings of masculine or feminine nature (assuming a fully developed emotional system). These are the "pathways" though I'm not sure anyone else would adopt this term.

Second, there is whether the person likes and pursues whichever emotional state. Just knowing how to go to Florida does not mean you actually want to go there. Indeed, I know how to get to Florida in part so that I don't find myself venturing too far in that direction. Thus this constitutes "the will".

Finally, there is the result of hormones, which at least in my own experience add a constant reminder "look at that path! That path will take you to Florida", such as it were.

GAHT only impacts the very last of these three, and will only help those dissatisfied specifically with the invasives and directives driven by hormones (and secondary jody structures such as breasts or an Adams apple which contribute to more visceral feelings and the feelings experienced looking in a mirror). Still, most trans people as I am aware want the invasive and driven directives associated with leading them, generally, to the behavior associated with their chosen emotional suite. In general trans women want to do the things that result in them feeling "feminine" rather than "masculine" and it's naturally hard to do that when the only suggestions you get out of your "subconscious" are how to feel "masculine".

Finally, from your own post Axulus:

desistance should no longer be used in clinical work or research

 

[Loren Pechtel]

As to "adult sexual function", I have yet to see a single piece of documentation even starting to imply that blockers "broke" that. For anyone. Something tells me that would be a huge concern, and a piece of immediate knowledge in the trans community. If it's merely about "organ development", the absence of "normal adult erections" and "normal adult penis size" would be straight up "shut up and take my money" territory for most trans women and eunuchs.

Yup. The really important part is the ability to experience sexual pleasure and orgasm.

The ability to get an erection and use it to stimulate someone is only relevant if that's something you seek to do. Lesbians have sex with no erections involved, obviously erections are not necessary for sexual enjoyment.

 

[ZiprHead]

My take on this:

It is very disappointing that trans activists are so strongly in favor of specific treatments that lack sound scientific evidence, acting as if it is settled science and terrorism/homicide to deny such treatments. This approach is backfiring as credibility and trust is completely eroded due to where the medical community is actually at in regards to the science.

This letter is a good overview of the concerns many in the medical community have over the use of puberty blockers for transgender youth:

---

Puberty blockers for gender dysphoric youth: A lack of sound science​

...
Received: 6 June 2022 Accepted: 7 June 2022 DOI: 10.1002/jac5.1691
LETTER TO THE EDITOR

---

Puberty blockers for gender dysphoric youth: A lack of sound science​

Dear Editor,
The medical transition of children and adolescents with gender dysphoria remains highly debated and there is significant divergence in policy internationally.1-7 Mills and colleagues' review the interventions that comprise the “gender-affirmative” care pathway, an approach currently promoted by many medical organizations in North America.6-8 We strongly agree with the authors that pharmacists have a responsibility to “understand the evidence,” and “place the well-being of the patient over any personal cultural beliefs.”8 However, we think the use of evidence to support the authors' claim that gonadotropin releasing hormone (GnRH)-analogs are fully reversible and have been shown to improve mental health, requires critical appraisal.
GnRH-analogs have been used for decades to successfully delay the early onset of puberty in children with precocious puberty.9 While generally considered safe for this indication, recent concern about impacts on polycystic ovarian disease, metabolic syndrome, and future bone density, have been raised.10 Even less is known about the use of GnRH-analogs to halt normally timed puberty in youth with gender dysphoria; no long-term, longitudinal studies of GnRH-analogs for this indication exist.
Puberty-related hormones have wide ranging effects on brain structure, function, and connectivity.11 Concerns have been raised that hormonal suppression of puberty may permanently alter neurodevelopment.2,11-13 The possible impact of puberty blockade on a young person's cognition has important implications for the decision to initiate exogenous cross-sex hormones and the capacity to give informed consent.14 Moreover, it has been suggested that pubertal suppression may alter the course of gender identity development, essentially “locking in” a gender identity that may have reconciled with biological sex during the natural course of puberty.13 Over 95% of youth treated with GnRH-analogs go on to receive cross-sex hormones.15 By contrast, 61-98% of those managed with psychological support alone reconcile their gender identity with their biological sex during puberty.16-18 This lack of evidence to support the durability of a transgender identification is conceptually consistent with significant psychosocial determinants of cross-sex identity, while the belief in immutable biological influences can best be described as a “current hypothesis.”19
There are also concerns that GnRH-analogs may have irreversible effects on sexual function and bone development. In some youth pubertal blockade at Tanner stage 2 followed by exogenous cross-sex hormones has resulted in a complete absence of adult sexual function.20 Profound effects on future sexual function may even occur when puberty is paused and later allowed to proceed, since the precise timing of hormone exposure during the peripubertal window is a determinative factor in adult sexual function.21 Finally, several studies have found that the expected pattern of bone mass accrual during adolescence does not occur when puberty is halted.22-25 The longterm clinical consequences of failure to accrue normal bone mass are unknown.
Uncertainties about long-term risks of medical transition are often overshadowed by the most potent argument provided by advocates of the affirmative model: failure to affirm a young person's transgender identity may result in suicide. Suicidal ideation and self-harming behaviors have been found to be higher than age-matched peers, but comparable to nongender dysphoric youth referred for management of other mental health diagnoses.26 However, the relevant question is whether affirmative care reduces suicide risk. Mills and colleagues assertion that GnRH-analogs have been shown to decrease lifetime suicidal ideation stems from a nonrepresentative, low-quality survey of transgender adults that has been thoroughly critiqued by others.27,28 Moreover, their claim that these drugs are effective for other mental health outcomes is at odds with recent systematic reviews that concluded there is little change from baseline to follow-up in depression, anxiety, body image, gender dysphoria, or psychosocial functioning.2,12,29 A seminal Dutch case-series of children with early-onset gender dysphoria is cited to support the assertion that GnRH-analogs improve psychological functioning.15 The magnitude of posttreatment improvement in mental health outcomes in this study was small and of questionable clinical significance. Furthermore, the applicability of results to the most common demographic presenting today, that is, adolescent females with preexisting mental health problems or neurodevelopmental conditions and no prior history of gender dysphoria, is questionable.4,30 A recent attempt to replicate the results of the Dutch study in the United Kingdom found no psychological benefit with GnRH-analogs, but treatment was associated with adverse effects on bone development.31
Multiple European countries that were pioneers in youth medical transition are now adopting a more cautious approach to the use of
GnRH-analogs and cross-sex hormones after their own evidence reviews failed to show mental health benefits and highlighted a profound lack of knowledge about harms. The UK's Cass review emphasized the paucity of data in their interim report stating, “it is important that it is not assumed that outcomes for, and side effects in, children treated for precocious puberty will necessarily be the same in children or young people with gender dysphoria.”13 The NHS updated guidance on treatment of gender dysphoria removed statements about the reversibility of GnRH-analogs and now states, “little is known about the long-term side effects of hormone or puberty blockers in children with gender dysphoria.”4 The Swedish Health Authority no longer offers GnRH-analogs to minors except in exceptional cases stating, “the risks of puberty suppressing treatment with GnRHanalogues and gender affirming hormonal treatment currently outweigh the possible benefits.”3 Finland has severely restricted their use and now recommend psychotherapy as first-line treatment for gender-dysphoric youth.2 Lastly, the French Académie Nationale de Médecine recently issued a press release stating, “great medical caution must be taken in children and adolescents, given the vulnerability, particularly psychological, of this population and the many undesirable effects, and even serious complications, that some of the available therapies can cause.”5 Although puberty-blockers and cross-sex hormones will still be available, the Académie emphasized, “the greatest reserve is required in their use, given side effects such as impact on growth, bone fragility, risk of sterility, emotional and intellectual consequences and, for girls, symptoms reminiscent of menopause.”5

https://accpjournals.onlinelibrary....?domain=p2p_domain&token=VMDIIBB55ARIBCZCTEFE

That being said, it seems pretty insane for state houses to be passing bans on these things. They certainly are not going to make a good decision, being guided by politics and culture wars than science. Setting up an independent commission of top medical professionals in this area to release recommendations and best practices I can support.

I can't help but think that the long term effects of puberty blockade are one of the oldest set of prognoses that have been recorded among all of human history, because more people have blocked puberty since before recorded history through castration, both self-initiated and externally forced.

The neurological developments during puberty are, from this perspective, completely unnecessary to fully actualized adult behavior.

We know full well what happens when someone grows up as a eunuch. They become a eunuch. Eunuchs are well understood throughout history and are clearly capable of being fully actualized adults. The Chinese government was literally run by eunuchs for thousands of years.

I could see this if there was no history of humans observing the effect of humans deprived of sex hormones, but there is DEEP history of it

Gifted WaPo article:

Survey of trans youths reports high satisfaction with gender-affirming care

Transgender and nonbinary youths who received gender-affirming medical care, such as puberty blockers and hormones, were largely satisfied with the treatments they received, according to a study published Monday in JAMA Pediatrics.

The data analyzed survey responses from more than 200 people who are part of the TransYouth Project, one of the largest and longest community-based studies on the experiences of transgender youths. The majority of respondents expressed satisfaction with the gender-affirming care they received, with only 4 percent — nine respondents — expressing some form of regret.

The release of the study comes as the Supreme Court is set to weigh whether restrictions on gender-transition care are constitutional. Though major medical associations have reported gender-affirming medical care decreases rates of suicide and depression in transgender individuals, more than two dozen states have banned such treatment, and the issue has become politically and culturally divisive nationwide.

“I wish we didn’t need research like this, but we do,” said Chris Barcelos, an associate professor of women’s gender sexuality studies at the University of Massachusetts at Boston, who was not involved in the recent study. “It’s important that there is more data to support a thing that trans people … know, which is that there’s a really low rate of regret and really high rates of satisfaction with gender-affirming care for young people.”

 

[Jarhyn]

As to "adult sexual function", I have yet to see a single piece of documentation even starting to imply that blockers "broke" that. For anyone. Something tells me that would be a huge concern, and a piece of immediate knowledge in the trans community. If it's merely about "organ development", the absence of "normal adult erections" and "normal adult penis size" would be straight up "shut up and take my money" territory for most trans women and eunuchs.

Yup. The really important part is the ability to experience sexual pleasure and orgasm.

The ability to get an erection and use it to stimulate someone is only relevant if that's something you seek to do. Lesbians have sex with no erections involved, obviously erections are not necessary for sexual enjoyment.

Also, another piece of highly relevant information here is actually a reddit thread (read: case study information) about someone who did not experience puberty until FAR later in life through a congenital difference that causes them to not produce testosterone: they were very clear that this lack of puberty did not actually prevent them from experiencing orgasm, just ejaculation.

Their condition did not make them socially incapable, or anything less than a person with the full weight of their experiences. They were not "immature" in any way but their appearance.

Also, I will note that I still get erections that can be painfully strong, with chemically suppressed testosterone... they just take longer to get there.

Finally, spoiler tags because it's rather sexually revealing:

Spoiler

orgasm for me, since I started treatment, requires (for lack of a better term), a "push". It's not a muscular "push" of broad forces... It's the neural kind of "push" you use to make the muscle twitch at all. I'm not sure if most people have the background to be able to separate the "willing" from the part where the muscle is "doing"?

But it's like that: like trying to flex a very specific muscle that doesn't strictly exist, or like wagging a tail that isn't there.

Before my pills, orgasms just built all on their own, like an AND gate where one branch was just "jumped to the rail", any touch could feel really good, and now that end is jumped to a circuit looking a magic number to be provided manually (for lack of a better way to say it).

Now, if I didn't know I COULD "push" on it, I would never be able to finish. I would maybe fiddle around with myself a bit on occasion wondering how that was supposed to feel good, and then quit after a bit when I got bored because I wouldn't know the secret.

I'll also note that this means I have entirely gnostic control over whether I orgasm from something (assuming it could tickle my pickle in the first place), these days.

 

[Loren Pechtel]

Gifted WaPo article:

Survey of trans youths reports high satisfaction with gender-affirming care

Transgender and nonbinary youths who received gender-affirming medical care, such as puberty blockers and hormones, were largely satisfied with the treatments they received, according to a study published Monday in JAMA Pediatrics.

The data analyzed survey responses from more than 200 people who are part of the TransYouth Project, one of the largest and longest community-based studies on the experiences of transgender youths. The majority of respondents expressed satisfaction with the gender-affirming care they received, with only 4 percent — nine respondents — expressing some form of regret.

The release of the study comes as the Supreme Court is set to weigh whether restrictions on gender-transition care are constitutional. Though major medical associations have reported gender-affirming medical care decreases rates of suicide and depression in transgender individuals, more than two dozen states have banned such treatment, and the issue has become politically and culturally divisive nationwide.

“I wish we didn’t need research like this, but we do,” said Chris Barcelos, an associate professor of women’s gender sexuality studies at the University of Massachusetts at Boston, who was not involved in the recent study. “It’s important that there is more data to support a thing that trans people … know, which is that there’s a really low rate of regret and really high rates of satisfaction with gender-affirming care for young people.”

And once again you beat me to it. I was going to post about that same research.

And note that half of those expressing some form of regret are continuing anyway--clearly they see it as a net positive even if they have some regrets about it. You can look back at something and have some desire for the other path even if you consider your choice to be the correct one.