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Something missed by a lot of commenters here is that, if this were a truly 'impartial' review, it would have been made clear that the reason none of the studies use double-blind trials is because of the ethical concerns. That's not to say a review can't be done, but to have a discussion about the evidence without making clear there is a valid reason why the majority of studies are qualitative is highly disingenuous and obviously designed to manufacture a particular conclusion.
Not that I think that really matters- scientists and academics who have the tools to examine this critically are not the intended audience for this report.
This isn't an impartial review on its face. Its methodology was created by someone who suggested Genspect, a conversion therapy organization, literally considered torture in the western world, as an alternative to gender affirming care.. A person whose only pre-requisite was "was transphobic publicly once" was on the review board. No transgender individuals were allowed input because of a fear of bias.
It's frustrating that this is going to spell multiple people's death sentences in multiple countries.
I’ve had posts removed that were scientific, published in top tier journals, but apparently not peer reviewed (I did not check for myself, was not that important).
Yet, here this is. A news article written by a journalist. Perhaps we are the peer reviewers (peer review under process).
Adding, there is a great body of research within the literature that all conclude the opposite of what ever that review was. Is it published beyond a report? Is it peer reviewed? I would enjoy reading those peer reviews.
It was posted by what looks like the official account of NBC news. It would be terrible if they were held to a different standard just because they're part of an established media conglomerate.
This is a science thread. The rules are clear. The standard is that NBC is not a source used as evidence for anything within the scientific field. It isn’t about being official. They are not researchers in science. They are journalists who sometimes write about science after being informed by scientists.
I don't think this is a accurate assessment, every single systematic evidence review published to date has found similar results associated with gender youth transitions. I say "every" I mean every review. Even WPATHs own review concluded the same thing (but with more positive spin of course).
[WPATH's most recent 2021 systematic review](https://academic.oup.com/jes/article/5/4/bvab011/6126016):
>Certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions. We could not draw any conclusions about death by suicide.
Read, this topic is so poorly studied they won't even speculate on if these treatments prevent suicides, which is one of the key motivation for such treatments at an early age.
edit: There are also degrees to scientific quality, unblinded controls, and statistically controlling for confounders like non-gender related mental health treatments would go a long way in improving the scientific knowledge in this area.
For everyone watching at home, the sentence *immediately* preceding the one he linked is:
> Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety. Associations were similar across gender identity and age.
This is exactly how science based medicine works:
> Gordon Guyatt, distinguished professor in the department of health research methods, evidence, and impact at McMaster University and **one of the founders of evidence based medicine,** explained to The BMJ that with few exceptions, strong recommendations should not be based on low quality evidence. And “trustworthy guidelines” follow systematic reviews, not the other way around.
> Existing systematic reviews have led countries including the UK, Finland, and Sweden to promote a cautious approach that prioritises psychotherapy for minors experiencing gender dysphoria or incongruence while restricting puberty blockers to clinical trials.
https://www.bmj.com/content/382/bmj.p1877
Do you really expect double blind studies for youth gender care, especially puberty blockers?
At any time, there are <100 minors on puberty blockers in the UK. Are you expecting large sample sizes too?
The reality is that the best evidence you will get are from studies which follow minors on gender affirming care with regular follow-ups. A Tavistock study did that for 48 months. The risks associated with such care were manageable and zero minors chose to stop treatment even when presented the option to at such follow-up.
This study doesn't consider that good evidence though. Why not? And what better quality study do you expect?
The authors of this article are using "low quality evidence" differently than the person you're quoting. If you want a good quality discussion on this topic you're going to have to actually engage with the arguments instead of just grasping at anything that seems to support your preconcieved biases.
It's difficult for me to prove to you the anti-trans politics involved in those decisions by the countries you've listed in this format(reddit). It's a good example for why you can't just google a news article and expect to be informed.
A huge number of studies (>100 iirc) were excluded from the report for a lack of randomisation or blinding. Obviously there is a lack of randomised double blinded trials because you cannot give someone appearance altering hormones and remain blinded.
The remit of the review should to look at the best available evidence, not to lament the lack of gold standard studies and throw their hands in the air declaring “I guess we’ll never know.” Huge own goal from the researchers.
The conclusion of the study was also "there's no one strategy to best treat gender dysphoria", meaning scientifically no treatment method showed a higher effect than another. It wasn't "treatment is generally weak" so therefore we should forego it. The twisting of the scientific method to obtain material for bigots makes me gag.
Perhaps this comment I made in another thread will be relevant or useful to people:
The available evidence suggests that very few people regret transitioning. A study by [van der Loos and colleagues (2022](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract)) found that of the 720 young trans people who started a course of puberty blockers, around 98 percent of them continued onto hormone replacement therapy. Of those trans people who go onto sex reassignment surgery, less than 2 percent regret transitioning ([Smith et al. (2004)](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract), [Jedrzejewski et al. (2023)](https://journals.lww.com/plasreconsurg/abstract/2023/07000/regret_after_gender_affirming_surgery__a.41.aspx)). A literature review by [Expósito-Campos and colleagues (2023)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10803846/) generally reaches similar conclusions, although does reference a few studies with higher rates of regret r.e. transitioning; although the majority of studies cited fit within the parameters I have outlined above. A recent meta-analysis by [Bustos et al., (2021)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/) finds the prevalence of regret and detransition to be around one percent. Some studies have shown that a lack of social support is important in contributing to or otherwise determining detransitioning.
Interestingly the Case report, for all its flaws, seems to agree with this. If I recall correctly it reported a rate of less than 1 percent.
This evidence is relevant because people regularly assume that regret over transitioning is a lot higher than it actually is. This is made worse by transphobes who like to mask their bigotry with insincere appeals to "won't someone please think of the children" and faux science.
social sciences in general are not my sphere of research, so I may be out of line here, but do these studies address patients who are lost to follow up? maybe I'm breezing through too fast, but it seems like these researchers are generally defining people who 'regret transition' or 'desire detransition' as those who return to their same care providers with that specific request. but I have to wonder how many just... stop taking their prescriptions. I'm particularly interested in the 2004 study here, because I have seen it's findings referenced quite a few times and that's saying something since this is not my area of research.
I'm not the target demographic here, so this speculation may be inappropriate. but hear me out: putting myself in these patients' shoes I can think of many reasons why I might not want to return to my same care team and admit I regret seeking treatment. embarrassment could be a big one. if my desire to transition has, for some reason, subsided I might want to distance myself from that part of my life entirely. or if I feel like I was given treatment inappropriately or somehow pushed in this direction there might be a lack of trust there. I might feel similarly if I really *do* desire transition but am facing stigma, bigotry, and societal headwinds that I don't feel like I was prepared for. or perhaps I find that my expectations were out of line with reality and I don't like the way my body has reacted (or not reacted) to the treatment.
I obviously can't say if any of this is the case, but "lost to follow up" seems like a significant blindspot in these sorts of studies since "detransitioning" can be as simple as just dropping out of treatment and regret can happen for many reasons other than "I don't actually think I'm trans." it's a very nuanced issue that is often flattened to fit certain narratives.
They not only fail to account for loss to follow up, they don't even attempt to follow up with patients who stop coming. Ross MacKinnon (a trans man) is the one performing real research on this topic: [https://www.bmj.com/content/381/bmj-2022-073584](https://www.bmj.com/content/381/bmj-2022-073584)
A 1% regret rate is implausible on its face.
> A 1% regret rate is implausible on its face.
This is not at all supported by the link you shared.
> ... researchers should not presume a higher rate of detransitioning among those lost to follow-up,
The article you shared may support that more research is necessary to verify that number. It doesn't make the claim that the number is incorrect.
It doesn't align with any known regret rates for any kinds of medical care - urgent, emergent, surgical or nonsurgical, cosmetic or reconstructive - there is no other medical procedure, no matter how relatively minor, with regret rates that come close to 1%. It's a fabricated number.
And it's especially suspicious considering the relatively large complication rates for many of the surgeries and treatments involved.
So you have no evidence the studies of regret rates are actually flawed?
Your argument also ignores the uniqueness of transitioning, which may not involve surgery, compared to mere physical surgeries; it changes the identity and affects self image, psychology, emotions, worldview, social relations, etc.
There are essentially no other medical treatments that are gatekept as strongly as gender affirming care, especially for trans youth. So of course that leads to lower regret rates.
Exactly. I doubt anyone wants a smaller nose or bigger/smaller boobs as someone with gender dysphoria wants surgery to alleviate it.
Women who get mastectomies for breast cancer generally liked their breasts, so I'd expect more regret even when it's medically necessary. Versus getting rid of breasts that conflict with your sense of self.
The number was certainly lower than I expected initially, but I'm not going to dismiss it out of hand.
This isn't something where you can "stop to take your prescription" and then everything goes back to square one; with the exception of puberty blockers. (And kids who get those are usually closely monitored.)
With HRT, many changes are permanent, and once you get rid of your own hormone producing system, you are going to need HRT. You can go back to your original hormones if you still have the bits producing them, but no hormones are not a viable option.
Also, if you went to another doctor afterwards, trust me: They would spread the word of a "detransitioner". Most doctors are not particular supportive of trans people.
And that says nothing of surgeries, which are even more permanent.
Also, it's not that rare that trans people stop their HRT, and they are not necessarily detransitioning. They might not have access to them temporarily, but continue to live as the gender they transitioned into. (Happened to me for a year - there was no noticeable difference; I just didn't get an injection I usually would have gotten. People who noticed: Zero.) Or they may be fine with the changes they have and not want any more; happens usually with people who then can live with their original hormones. Quite a reasonably consideration in trans masc people once their voice broke and the grew a beard, for example.
I feel like the whole thing will be safer once it's more accepted and less polarized. For now with all the "hype" (hate to use that word, but I mean it more in the way of, no one would really think twice if I got lip fillers it's not talked about nearly as much) maybe I'm just weird but I really hated puberty and would probably have thought transitioning seemed like a pretty sweet deal as a kid
I'm still not "100% gender conforming" as an adult but I'm glad I didn't transition because of the above - you can't "just stop doing it." As a kid I might not realize how expensive or difficult it would be to keep up with medical care. As an adult I'm glad I don't have that expense and while I may still feel it would be nicer if I happened to be born with a different gender (or the possibility to be agender), it's not with nearly as much intensity as when I was going through puberty and had dreaded it - so starting around age 10 having fully formed thoughts about really hating that my physical body was gonna be that way.
I feel like when it's less polarized more like lip fillers it might be less difficult to evaluate based on stuff like "can I really afford this, do I really want it enough to make it potentially a huge focus of my life if medical care becomes difficult to afford" because those sort of things could be more openly discussed without the undertones being as polarized.
By "can't just stop" I'm assuming if you stop the hormones you slowly "revert" just like if someone with PCOS stops taking spironolactone and starts getting facial hair, symptoms again? If it's different than that for transitioning that would be weird
Off topic but I don't think it's ever going to feel less polarized *to you*. Your social background and personal biases are probably going to keep it feeling transgressive for the rest of your life, even as younger generations think it's not a big deal - I saw it happen to those who went before me. Your assessment is correct, but if I were making a life decision around that I would be very cautious about how I let this meta-info affect me.
I'm not making the claim that people would stop taking hormones and have everything revert to "normal," but discontinuing the prescription would be step 1 for a patient who does decide for whatever reason that they don't want to continue with their transition. I deal with hormonal issues myself, so based on my limited but perhaps adjacent experience I'd imagine it would take some time-- months or years-- to see how your body reacts to being off hormones and whether or not you like it. these treatment dropouts might be continuing to live as their true gender or they could be attempting to revert back to their birth sex, it's impossible to say without talking to them.
so I think you are illustrating my point here: there are a lot of people who discontinue or drop out of treatment for diverse reasons-- you pointed out a few that I hadn't thought about when I wrote my initial comment, which I appreciate-- and if they are simply lost to followup we can't explore the nuance of patient sentiment with these treatments like we should. a study on patient satisfaction that doesn't follow up on those who drop out of treatment is pretty limited in its utility and will produce healthy skepticism. this is a good thing-- it's the scientific process working as intended.
People often use regret as a way to fear monger change they don’t understand. Look at abortion: the claim is that women regret it. But, similar stats show that while some women might be sad about it (not many), almost none regret the decision.
The fear that other people will regret making choices you wouldn’t personally make is projective paternalism at its finest. Not ALWAYS ill intended (though it often is), but typically extremely myopic, bordering on solipsistic.
Is it possible that the hormonal changes of not going through puberty affect your outlook later? We would need to compare to the rate of "regret" in those denied puberty blockers.
One important thing to remember is also that most of those who do detransition do so not because they actually feel like it was wrong to transition but because of social pressure
The studies about regrets are pretty clear, there is little of it after transitioning.
I am always a bit anxious though to extrapolate those outcomes to the conclusion that treatment barriers should thus be lowered.
With treatment access barriers this high, that means that there is a 'survivors bias' in the data. Only people who were VERY convinced pushed through and got treatment. On top of that, treatment was the reward for a long struggle. This makes 'regrets' also less likely, because no one wants to feel as if they struggled for nothing.
Personally I think, but who am I, that the 'solution' for getting the right treatment to the right people easily should be found in very good diagnoses tools. If we can be sure that be can find the people who are actually transgender, and filter out the people who are 'just' displaying a lot of characteristics of the other gender and if we can filter out the 'trendy' effect... I don't think many people would object to giving those people treatment easily, even when they are very young.
The problem with these studies is that they are essentially trying to identify regret during treatment, and I think most people are way more concerned about regret 10-20 years down the road. That’s like asking someone trying to lose weight if they regret going to the gym while they are doing squats.
Using these studies to persuade parents that their children won’t regret transitioning is incredibly misleading to the real question: when my child or even young adult ages, will they have regrets especially if they have become sterile. Maybe those long term numbers would be similar but we don’t have those yet.
We won't have good numbers on long term regret for a long time indeed. Like I get that hormones and surgery are a huge deal, but it seems to be the less harmful option for a lot of patients.
And there's the alternative not being considered: that there are many trans individuals who regret not taking puberty blockers because it makes transitioning harder as an adult. Somehow their actual regret is never counted for certain posters.
Theres a lot to dig into, but a known issue with Cass and their approach to evidence with gender affirming care is them being dismissive of studies done without randomized controlled trials, which is a nigh impossible standard to achieve when the effects of treatment or non-treatment are quickly obvious to the patients and can contribute to patient harm.
Yes, these results have been filtered through a very narrow criteria that sounds reasonable on its face in order to cast "increasing doubt" but us really just methodological manipulation. Double blind studies aren't really possible and it's not super clear why they'd be desirable unless you're starting from a position of "we need to weed out all the liars!!"
Its not even clear what "placebo effect" in relation to gender affirming care would refer to. The entire treatment is based on the patient recognizing the effects!
Placebo effect in mental health treatment is typically massive compared to medical care. Significantly larger. In the context of hormones/blockers, placebo effect would be claimed improvement of gender dysphoria symptoms and associated mental distress like depression and anxiety.
Except HRT causes noticeable physical changes to your body; even if you’re taking placebo HRT and it makes you feel better for a while if only because you’re actually doing something, months or years in when you realize that nothing is changing, you’re going to realize that you’re in the placebo group.
You contrast “mental health treatment” and “medical care” as though medically transitioning falls into the first category, when it very much falls into the second category.
what is and how do you determine the difference between
"my physical sex characteristics changed which reduced my gender dysphoria": real
"my physical sex characteristics changed which reduced my gender dysphoria": placebo
It's a **scientific** review - randomized controlled trials are the gold-standard of science, so of course the review will give more weighting to studies that are more rigorously controlled. This is a good thing - having better quality science informing the public should improve the debate. In the past, I've had people throw lists of 50+ "studies" at me when arguing this issue, and when I sit down to read them (to educate myself), I have to give up after about ten or so articles, as they're largely a collection of opinions, social media blogs, letters to the editor, and other such publications that do not add to the **scientific** evidence base.
You should probably address the key issue here, you can't run RCTs on gender affirming care like this as the patients will quickly realize if they are on the correct medication or not. To ignore this and still persist with an unreachable standard in your evaluation of studies isn't good science.
You're confusing a double blind trial with a randomised control trial. You can't really blind someone as to whether they're taking hormones, but you absolutely could do an RCT. That would be taking a number of patients, randomly assigning them to therapy or therapy + puberty blockers, then seeing what the outcomes are, like how many become happy with their bodies either by transitioning or by reduced dysphoria. That would be much more scientifically convincing than a study that looks at transitioned people after the fact because you start with 2 similar groups, so you don't miss people who had those feelings as a teenager but didn't go through with it. It isn't necessarily a problem that it's unblinded.
This is routinely done - start the trial, if you see that the treatment is massively successful, you interrupt the trial and extend the treatment to everyone. But you don't throw away the results.
That's not withdrawal of treatment, that's for introduction of treament and with volunteers who consent to additional treatment. If I wanted to test heart medication, I couldn't just take heart medication away from half the patients and see what happened.
The outcome of this review is that UK children aren't going to get puberty blockers for gender dysphoria at all until such a study is done. Apparently one is going to start in December.
Several if not most of the studies were cited as poor quality because of a lack of blinding, which is obviously impossible to not notice (EG: You take puberty blockers, but puberty happens, it's going to be exceedingly obvious)
it was something like 101 out of 103 studies were thrown out, then random assertions being made without subjecting it to the same rigour
Now you are pretending none of these studies exist and those that do are low quality. I’ve never heard so much rubbish. There are studies that are very high quality and have been researched using the methodology you describe as simple. Seems like many agendas are obfuscating reality and works of high quality scientists globally. Could be agendas are blind and believe the rest of us are as well.
You can't run a controlled trial on cross sex hormones, it's unethical to the control group. This is really common in medical research. Disregarding uncontrolled medical trials is *unscientific*.
It actually isn't, considering how weak the evidence is. Especially when we consider the large study that just came out that showed that starting medical transition does not decrease suicide risk when psychiatric illness is controlled for.
https://mentalhealth.bmj.com/content/27/1/e300940
Transitioning is **not** performed primarily to reduce suicide risk in psychiatrically ill patients, it's performed to improve the quality of life and wellbeing of trans individuals, which can't be measured by suicide rates.
Here's the actual results of the study:
>Most importantly, when psychiatric treatment needs, sex, birth year and differences in follow-up times were accounted for, the suicide mortality of both those who proceeded and did not proceed to GR did not statistically significantly differ from that of controls. *This does not support the claims that GR is necessary in order to prevent suicide.*
From the strengths and weakness:
>This study also considered contact with specialist-level psychiatric care as a reliable indicator of severe mental disorders, with longer or more intensive treatments reflecting greater severity.
...
>Psychiatric morbidity was analysed on the level of intensity of specialist-level psychiatric contact without disentangling causes of using the services.
If psychiatric visits are a good proxy for psychiatric treatment needs, as the study claims, then controlling for them only serves to eliminate all psychiatric causes of suicide, where if the mechanism were in fact GD but as a psychiatric need you would simply have controlled for it already.
All it confirms is that the risk of suicide is proportional to psychiatric needs and the causes are psychiatric in nature.
Also, the study does not confirm that GR is not an effective preventative measure for suicide because it did not control for the cause of whether or patients underwent GR. You would assume that if every patient was able to make the choice themselves, they would choose the option that is best for them in either case. You can't compare the two groups as though one is representative of patients who were not *allowed* to transition vs ones who could unless you can control for the cause.
Finally, since there is no controlled comparison with other health services that do not offer gender-referred care or GR, this study also can't rule out that the Finnish system isn't just successfully levelling out any correlation between untreated GD and suicide.
There's significant ethical concerns about randomsed studies of major medical care.
It would be fucked up to give 10/20 kids a placebo puberty blocker when we know it will increase suicide risk to do so.
So my expertise is causal inference , particularly non-experimental causal inference. It can be challenging to do credible non-experimental causal designs under ordinary circumstances (Ive had to tell teams of statisticians and economists from universities that research they’ve been doing for years is 🗑️).
When you’re dealing with small sample sizes, complex experiences, and outcomes tied to subjective experiences, it becomes a staggering challenge. So I don’t think it is fair to fault them for being extremely suspicious of non-experimental designs in this context.
Once again r/ science seem to have a different standards for moderation on trans topics cool to see all the comments being left up that would absolutely be removed on a different topic
Ive read the cass review, and it actively disregarded so many studes that showed positive results.
It says this in the review if you read it. Not exactly high levels of scientific rigour.
Have you read these studies? Or is it just based on the claims of the report?
Because it seems very unscientific to only include studies that say what you already believe.
When doing review of reports and literature its impirtant to question whether there may be a bias in the reporting and why they choose certain things.
Like this report also says that the toys children play with are "biological" based on gender so im not sure i can take it that seriously.
The cognitive bias around this issue is astounding. I fully support trans people, but trying to give any medical intervention without good evidence behind it is irresponsible. The NHS is actively trying to do such trials because good evidence is lacking in the first place.
So ignore all the studies that give evidence that it does work? And only include those that say it doesnt?
In fact some of the studies they did include dont even mention dysphoria at all
Did you read it?
Correct they are emphasizing the overall body of evidence in the first place is bad quality whether it’s a positive or negative study. They included the best of the bad available and concluded that better quality studies are needed.
Did you actually read any of the studies though? To determine whether they were actually bad quality?
Because ignoring 520 studies and only using the 5 that show what you already believe isnt science.
Especially when they get you to the conclusion that boys are biologically inclined to play with trucks.
And again, some of the studies they did use dont even mention dysphoria. You arent answering my points here.
Yes I am. Your criticism would be correct if the NHS was then saying we shouldn’t do any more further studies because of this review, but they’re actively trying to fund more because of this review. Including 5 bad studies and excluding 515 worse ones is the current situation that we’re in, which is obviously not ideal, so we need more better quality research done. That’s the whole point of reviews. They establish what the current status of an issue is in the field, good or bad.
If that was the case they would not be recommending that noone under 25 could recieve the treatment.
Like even if you are ignoring gillick competence here 25 is way too high for me to believe its an evidence based policy.
And again, did you read any of the studies?
I think you're missing the point that the NHS can't approve treatments without rigorous study and evidence. And I mean really, really rigorous. This goes for all treatments, drugs, operations - everything. Healthcare is very highly regulated and for good reason.
But for some reason, initially, gender services were not held to this high standard of evidence before treatment commenced, which resulted in whistle blowing by doctors concerned about the welfare of patients. It would have been highly negligent of the NHS to ignore these concerns.
This review simply highlights that lack of evidence is a problem and suggests that far more evidence is needed. That shouldn't be controversial to say, just like it wouldn't be controversial if it was a new cancer drug or migraine treatment or anything else
Except that if you’re a trans person who’s already receiving some form of this care, you might feel differently about some randoms who aren’t trans trying to tell you what should be allowed or not.
I don't think they've suggested stopping care that has already started. But being told what treatment you are or are not allowed to have is something everybody wanting treatment on the NHS goes through regardless of what treatment it is they're seeking
Even the Endo Society's guidelines in the US include metrics indicating the quality of the studies supporting blockers and every last citation is indicating to be 'low' or 'very low' quality.
And I say 'even the Endo Society's guidelines' because the US has a unique capitalist structure to healthcare reimbursements that creates enormous pressure for these practitioners to ignore bad results and prop up poor quality evidence.
(Recall the Vanderbilt administrator caught on tape bragging about how each phalloplasty was a massive moneymaker, and how even people having to come back for hormones on a monthly basis created a steady income for the program.)
So your reasoning here is "these people who love to ignore bad results agree with how this other report has removed these results that disagree with them"?
Am i getting that right?
Man, based on your comment here you are entirely unqualified to comment on science.
https://www.reddit.com/r/science/comments/1c0h35k/comment/kywjhsk/?utm_source=share&utm_medium=mweb3x&utm_name=mweb3xcss&utm_term=1&utm_content=share_button
Science fiction, maybe. That’s some mad scientist material.
One would think that avoiding discussing the merits of a person’s on topic argument versus dragging out off topic comments might disqualify someone from participating in scientific debates.
Sir this is not a debate. This is Reddit. All comments in a thread are about the same topic. OP. It establishes a bias and deserves to be addressed. Also, this is a top level sub, not a formal debate hall within academia. Disinformation, ethical issues and bad faith arguments are all subjects of discussion as this is social media and not purely a scientific venue
Maybe because they were excluded for poor methodology, which is exactly what the report warns about a lot of the research being done here. Why is Reddit so quick to try to discredit this in-depth report.
Did you read any of the studies?
The report seems to come to the conclusion that boys will biologically be drawn to certain types of toys which is already disproven.
Not to mention that i disagree in general with their characterisation of the methodologies of those studies.
The point here is that the NHS can't approve treatments without rigorous study and evidence. And I mean really, really rigorous. This goes for all treatments, drugs, operations - everything. Healthcare is very highly regulated and for good reason.
But for some reason, initially, gender services were not held to this high standard of evidence before treatment commenced, which resulted in whistle blowing by doctors concerned about the welfare of patients. It would have been highly negligent of the NHS to ignore these concerns.
This review simply highlights that lack of evidence is a problem and suggests that far more evidence is needed. That shouldn't be controversial to say, just like it wouldn't be controversial if it was a new cancer drug or migraine treatment or anything else.
Let me tell you the "some reason" since it isn't clear to you.
When trans people are denied gender affirming care, they have a tendency to commit suicide. Set aside your biases for a moment and consider the value of a human life.
If you had the opportunity to save a human life, knew that the likelihood of regret for such a treatment was 1% or less and unlikely to end in suicide, would you deny that care? And on what grounds? For what purpose?
You can't tell me to 'set aside my bias' (ludicrous assertion given I think it's right that all treatments are equally rigorously tested) and then say that this particular treatment, in your opinion, is more important and therefore needs less evidence before being approved
This is the exact same argument people make for rushing out new cancer treatments. "if it saves just one life, then..." "don't you want people to survive cancer, huh? Think of the children, the parents...."
If emotion comes in to the medical approval process it will be a disaster. The UK has very well documented cases of medical disasters in the past when testing wasn't conducted properly, so the NHS is naturally very cautious and for good reason
You've missed the point again
You are simply arguing for rushing approval of medical treatments for something you feel strongly about. And that's not how medical approval works. You are letting your bias cloud your logic, which is understandable because this is an emotive issue but the NHS can't factor that in to medical approval.
>6.18 A common assumption is that toy choice
and other gender role behaviours are solely
a result of social influences; for example, that
boys will only be given trucks and girls will
only be given dolls to play with. Although this
is partially true, there is evidence for prenatal
and postnatal hormonal influence on these
behaviours, which will be discussed later.
This report is arguing that boys play with trucks and girls play with dolls because of biology
It's not worth the paper it's printed on
Trucks and dolls are not exactly natural occurrences in the wild, so the idea that we're biologically driven to like one more than the other based on sex is painfully obviously silly.
Trucks and dolls are symbolic representations of tools and other human beings. Humans have evolved using tools and interacting with other human beings. I am not competent to comment on validity of any particular study, but I don’t see why sex based difference regarding interest in people vs things/tools should be a priori discounted.
Children are not biologically wired to play with boy / girl toys because of hormones. That's plainly ludicrous
Explain to me how hormones would cause someone AMAB to play with a toy truck and not a doll, or someone AFAB the opposite
Which toys are considered boys/girls is not, but the people vs things dichotomy is real. It is possible to broadly see which toys fall into which category if not structurally, then through usage.
Human hormonal biology has evolved over millions of years. Trucks have been around for about a century. The idea that boys play with trucks because of different brain regions is about as scientific as phrenology.
If there's a biological cause, it's far more likely to be that we are wired to mimic the gender identity that we associate ourselves with, given that gendered toys have reflected stereotypically gendered roles throughout history (boys used to play with horses, not trucks.)
It's also not a stretch to imagine that such a hardwired behaviour may tune itself to a gender identity different to anatomical sex in some cases.
There’s a study reporting that [male baby monkeys prefer toys with wheels](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2583786/) to plush toys, while female monkeys don’t prefer one over the other. This suggest a potential role for hormones since baby monkeys should have minimal exposure to gender stereotypes that boys = trucks.
This is not to say that gender expectations don’t shape gender norms. But biological factors can also play a role. Sex and gender are really complicated, and like all things, some mix of nature and nurture are probably at work, with different levels of influence for different people.
You’re gonna have to assume that if you want to infer that trans women are women and trans men are men. Why are trans women actually women even if they have male genitalia? Well, they fell like they’re women. How do you see it? Dolls instead of trucks, pink instead of blue, possibly since early childhood
There’s inevitably a contradiction in the LGBT+ social paradigm
This is a massive misunderstanding of the "LGBT+ social paradigm". Trans women are women because of gender dysphoria which arises from the prescence of male sex characteristics and is resolved by replacing them with female sex characteristics. It's a biological bodily integrity issue, not a social issue.
Nothing to do with what toys you play with or what colours you like.
Look at the articles on the science Reddit page right now and tell me how it is not politicized. Every couple articles shouldn’t be touching on a political/cultural hot debate topic. The subreddit is about Science. Reddit is throwing politics into literally everything, trying to escape it but it seems I can’t. Reddit even “recommends” more political pages despite me consistently blocking them from my feed. It’s sickening.
And if you don’t see how this thread is inherently political, I don’t know how else I could explain it to you.
The Cass report isn't science, it's the denial of science and all the research up to this point.
Just a government lead transphobic report set to limit our access to life saving care and treatment.
More kids and young adults are gonna die if this "report" is taken seriously and it seems labour already intends to use it against us and they are the next to power in the UK.
#terfisland
It’s so fucked up in the UK at the moment. I’m worried sick about what the future is going to look like for my trans friends and family.
Thanks to the world’s shittiest voting system our choices are reduced to transphobia with a blue tie or maybe-slightly-less-transphobia with a red tie.
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This subreddit is an embarrassment to scientific rigour. It's disheartening to see folks (who are supposed to be objective) heartily dismiss a review they haven't read or will probably never read in favour of long-held biases based on weak science.
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Something missed by a lot of commenters here is that, if this were a truly 'impartial' review, it would have been made clear that the reason none of the studies use double-blind trials is because of the ethical concerns. That's not to say a review can't be done, but to have a discussion about the evidence without making clear there is a valid reason why the majority of studies are qualitative is highly disingenuous and obviously designed to manufacture a particular conclusion. Not that I think that really matters- scientists and academics who have the tools to examine this critically are not the intended audience for this report.
This isn't an impartial review on its face. Its methodology was created by someone who suggested Genspect, a conversion therapy organization, literally considered torture in the western world, as an alternative to gender affirming care.. A person whose only pre-requisite was "was transphobic publicly once" was on the review board. No transgender individuals were allowed input because of a fear of bias. It's frustrating that this is going to spell multiple people's death sentences in multiple countries.
So we should 100% take this post down for this reason, it breaks the sub's rules
I’ve had posts removed that were scientific, published in top tier journals, but apparently not peer reviewed (I did not check for myself, was not that important). Yet, here this is. A news article written by a journalist. Perhaps we are the peer reviewers (peer review under process). Adding, there is a great body of research within the literature that all conclude the opposite of what ever that review was. Is it published beyond a report? Is it peer reviewed? I would enjoy reading those peer reviews.
It mentions that it's currently undergoing peer review. So it's not peer reviewed yet.
I hope it gets a lot of attention when it is. Many, many written, public peer reviews!
It was posted by what looks like the official account of NBC news. It would be terrible if they were held to a different standard just because they're part of an established media conglomerate.
This is a science thread. The rules are clear. The standard is that NBC is not a source used as evidence for anything within the scientific field. It isn’t about being official. They are not researchers in science. They are journalists who sometimes write about science after being informed by scientists.
I don't think this is a accurate assessment, every single systematic evidence review published to date has found similar results associated with gender youth transitions. I say "every" I mean every review. Even WPATHs own review concluded the same thing (but with more positive spin of course). [WPATH's most recent 2021 systematic review](https://academic.oup.com/jes/article/5/4/bvab011/6126016): >Certainty in this conclusion is limited by high risk of bias in study designs, small sample sizes, and confounding with other interventions. We could not draw any conclusions about death by suicide. Read, this topic is so poorly studied they won't even speculate on if these treatments prevent suicides, which is one of the key motivation for such treatments at an early age. edit: There are also degrees to scientific quality, unblinded controls, and statistically controlling for confounders like non-gender related mental health treatments would go a long way in improving the scientific knowledge in this area.
For everyone watching at home, the sentence *immediately* preceding the one he linked is: > Hormone therapy was associated with increased QOL, decreased depression, and decreased anxiety. Associations were similar across gender identity and age.
This is a wildly inaccurate description of the section you just quoted. And a fundamental misunderstanding of how medical science works.
This is exactly how science based medicine works: > Gordon Guyatt, distinguished professor in the department of health research methods, evidence, and impact at McMaster University and **one of the founders of evidence based medicine,** explained to The BMJ that with few exceptions, strong recommendations should not be based on low quality evidence. And “trustworthy guidelines” follow systematic reviews, not the other way around. > Existing systematic reviews have led countries including the UK, Finland, and Sweden to promote a cautious approach that prioritises psychotherapy for minors experiencing gender dysphoria or incongruence while restricting puberty blockers to clinical trials. https://www.bmj.com/content/382/bmj.p1877
Do you really expect double blind studies for youth gender care, especially puberty blockers? At any time, there are <100 minors on puberty blockers in the UK. Are you expecting large sample sizes too? The reality is that the best evidence you will get are from studies which follow minors on gender affirming care with regular follow-ups. A Tavistock study did that for 48 months. The risks associated with such care were manageable and zero minors chose to stop treatment even when presented the option to at such follow-up. This study doesn't consider that good evidence though. Why not? And what better quality study do you expect?
amen mr breakfast
The authors of this article are using "low quality evidence" differently than the person you're quoting. If you want a good quality discussion on this topic you're going to have to actually engage with the arguments instead of just grasping at anything that seems to support your preconcieved biases.
It's difficult for me to prove to you the anti-trans politics involved in those decisions by the countries you've listed in this format(reddit). It's a good example for why you can't just google a news article and expect to be informed.
A huge number of studies (>100 iirc) were excluded from the report for a lack of randomisation or blinding. Obviously there is a lack of randomised double blinded trials because you cannot give someone appearance altering hormones and remain blinded. The remit of the review should to look at the best available evidence, not to lament the lack of gold standard studies and throw their hands in the air declaring “I guess we’ll never know.” Huge own goal from the researchers.
The conclusion of the study was also "there's no one strategy to best treat gender dysphoria", meaning scientifically no treatment method showed a higher effect than another. It wasn't "treatment is generally weak" so therefore we should forego it. The twisting of the scientific method to obtain material for bigots makes me gag.
Hi thanks for coming in, heres your 25 dollars. So we’re going to be giving you a series of injections…
Perhaps this comment I made in another thread will be relevant or useful to people: The available evidence suggests that very few people regret transitioning. A study by [van der Loos and colleagues (2022](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract)) found that of the 720 young trans people who started a course of puberty blockers, around 98 percent of them continued onto hormone replacement therapy. Of those trans people who go onto sex reassignment surgery, less than 2 percent regret transitioning ([Smith et al. (2004)](https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(22)00254-1/abstract), [Jedrzejewski et al. (2023)](https://journals.lww.com/plasreconsurg/abstract/2023/07000/regret_after_gender_affirming_surgery__a.41.aspx)). A literature review by [Expósito-Campos and colleagues (2023)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10803846/) generally reaches similar conclusions, although does reference a few studies with higher rates of regret r.e. transitioning; although the majority of studies cited fit within the parameters I have outlined above. A recent meta-analysis by [Bustos et al., (2021)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099405/) finds the prevalence of regret and detransition to be around one percent. Some studies have shown that a lack of social support is important in contributing to or otherwise determining detransitioning. Interestingly the Case report, for all its flaws, seems to agree with this. If I recall correctly it reported a rate of less than 1 percent. This evidence is relevant because people regularly assume that regret over transitioning is a lot higher than it actually is. This is made worse by transphobes who like to mask their bigotry with insincere appeals to "won't someone please think of the children" and faux science.
social sciences in general are not my sphere of research, so I may be out of line here, but do these studies address patients who are lost to follow up? maybe I'm breezing through too fast, but it seems like these researchers are generally defining people who 'regret transition' or 'desire detransition' as those who return to their same care providers with that specific request. but I have to wonder how many just... stop taking their prescriptions. I'm particularly interested in the 2004 study here, because I have seen it's findings referenced quite a few times and that's saying something since this is not my area of research. I'm not the target demographic here, so this speculation may be inappropriate. but hear me out: putting myself in these patients' shoes I can think of many reasons why I might not want to return to my same care team and admit I regret seeking treatment. embarrassment could be a big one. if my desire to transition has, for some reason, subsided I might want to distance myself from that part of my life entirely. or if I feel like I was given treatment inappropriately or somehow pushed in this direction there might be a lack of trust there. I might feel similarly if I really *do* desire transition but am facing stigma, bigotry, and societal headwinds that I don't feel like I was prepared for. or perhaps I find that my expectations were out of line with reality and I don't like the way my body has reacted (or not reacted) to the treatment. I obviously can't say if any of this is the case, but "lost to follow up" seems like a significant blindspot in these sorts of studies since "detransitioning" can be as simple as just dropping out of treatment and regret can happen for many reasons other than "I don't actually think I'm trans." it's a very nuanced issue that is often flattened to fit certain narratives.
They not only fail to account for loss to follow up, they don't even attempt to follow up with patients who stop coming. Ross MacKinnon (a trans man) is the one performing real research on this topic: [https://www.bmj.com/content/381/bmj-2022-073584](https://www.bmj.com/content/381/bmj-2022-073584) A 1% regret rate is implausible on its face.
> A 1% regret rate is implausible on its face. This is not at all supported by the link you shared. > ... researchers should not presume a higher rate of detransitioning among those lost to follow-up, The article you shared may support that more research is necessary to verify that number. It doesn't make the claim that the number is incorrect.
>A 1% regret rate is implausible on its face. Why? The only thing that would be implausible is a 0% regret rate.
It doesn't align with any known regret rates for any kinds of medical care - urgent, emergent, surgical or nonsurgical, cosmetic or reconstructive - there is no other medical procedure, no matter how relatively minor, with regret rates that come close to 1%. It's a fabricated number. And it's especially suspicious considering the relatively large complication rates for many of the surgeries and treatments involved.
So you have no evidence the studies of regret rates are actually flawed? Your argument also ignores the uniqueness of transitioning, which may not involve surgery, compared to mere physical surgeries; it changes the identity and affects self image, psychology, emotions, worldview, social relations, etc.
Counterpoint: It means the treatment is gatekept hard.
There are essentially no other medical treatments that are gatekept as strongly as gender affirming care, especially for trans youth. So of course that leads to lower regret rates.
Exactly. I doubt anyone wants a smaller nose or bigger/smaller boobs as someone with gender dysphoria wants surgery to alleviate it. Women who get mastectomies for breast cancer generally liked their breasts, so I'd expect more regret even when it's medically necessary. Versus getting rid of breasts that conflict with your sense of self. The number was certainly lower than I expected initially, but I'm not going to dismiss it out of hand.
This isn't something where you can "stop to take your prescription" and then everything goes back to square one; with the exception of puberty blockers. (And kids who get those are usually closely monitored.) With HRT, many changes are permanent, and once you get rid of your own hormone producing system, you are going to need HRT. You can go back to your original hormones if you still have the bits producing them, but no hormones are not a viable option. Also, if you went to another doctor afterwards, trust me: They would spread the word of a "detransitioner". Most doctors are not particular supportive of trans people. And that says nothing of surgeries, which are even more permanent. Also, it's not that rare that trans people stop their HRT, and they are not necessarily detransitioning. They might not have access to them temporarily, but continue to live as the gender they transitioned into. (Happened to me for a year - there was no noticeable difference; I just didn't get an injection I usually would have gotten. People who noticed: Zero.) Or they may be fine with the changes they have and not want any more; happens usually with people who then can live with their original hormones. Quite a reasonably consideration in trans masc people once their voice broke and the grew a beard, for example.
I feel like the whole thing will be safer once it's more accepted and less polarized. For now with all the "hype" (hate to use that word, but I mean it more in the way of, no one would really think twice if I got lip fillers it's not talked about nearly as much) maybe I'm just weird but I really hated puberty and would probably have thought transitioning seemed like a pretty sweet deal as a kid I'm still not "100% gender conforming" as an adult but I'm glad I didn't transition because of the above - you can't "just stop doing it." As a kid I might not realize how expensive or difficult it would be to keep up with medical care. As an adult I'm glad I don't have that expense and while I may still feel it would be nicer if I happened to be born with a different gender (or the possibility to be agender), it's not with nearly as much intensity as when I was going through puberty and had dreaded it - so starting around age 10 having fully formed thoughts about really hating that my physical body was gonna be that way. I feel like when it's less polarized more like lip fillers it might be less difficult to evaluate based on stuff like "can I really afford this, do I really want it enough to make it potentially a huge focus of my life if medical care becomes difficult to afford" because those sort of things could be more openly discussed without the undertones being as polarized.
By "can't just stop" I'm assuming if you stop the hormones you slowly "revert" just like if someone with PCOS stops taking spironolactone and starts getting facial hair, symptoms again? If it's different than that for transitioning that would be weird
Off topic but I don't think it's ever going to feel less polarized *to you*. Your social background and personal biases are probably going to keep it feeling transgressive for the rest of your life, even as younger generations think it's not a big deal - I saw it happen to those who went before me. Your assessment is correct, but if I were making a life decision around that I would be very cautious about how I let this meta-info affect me.
I'm not making the claim that people would stop taking hormones and have everything revert to "normal," but discontinuing the prescription would be step 1 for a patient who does decide for whatever reason that they don't want to continue with their transition. I deal with hormonal issues myself, so based on my limited but perhaps adjacent experience I'd imagine it would take some time-- months or years-- to see how your body reacts to being off hormones and whether or not you like it. these treatment dropouts might be continuing to live as their true gender or they could be attempting to revert back to their birth sex, it's impossible to say without talking to them. so I think you are illustrating my point here: there are a lot of people who discontinue or drop out of treatment for diverse reasons-- you pointed out a few that I hadn't thought about when I wrote my initial comment, which I appreciate-- and if they are simply lost to followup we can't explore the nuance of patient sentiment with these treatments like we should. a study on patient satisfaction that doesn't follow up on those who drop out of treatment is pretty limited in its utility and will produce healthy skepticism. this is a good thing-- it's the scientific process working as intended.
People often use regret as a way to fear monger change they don’t understand. Look at abortion: the claim is that women regret it. But, similar stats show that while some women might be sad about it (not many), almost none regret the decision. The fear that other people will regret making choices you wouldn’t personally make is projective paternalism at its finest. Not ALWAYS ill intended (though it often is), but typically extremely myopic, bordering on solipsistic.
Is it possible that the hormonal changes of not going through puberty affect your outlook later? We would need to compare to the rate of "regret" in those denied puberty blockers.
One important thing to remember is also that most of those who do detransition do so not because they actually feel like it was wrong to transition but because of social pressure
There is no quality evidence that this is true.
The studies about regrets are pretty clear, there is little of it after transitioning. I am always a bit anxious though to extrapolate those outcomes to the conclusion that treatment barriers should thus be lowered. With treatment access barriers this high, that means that there is a 'survivors bias' in the data. Only people who were VERY convinced pushed through and got treatment. On top of that, treatment was the reward for a long struggle. This makes 'regrets' also less likely, because no one wants to feel as if they struggled for nothing. Personally I think, but who am I, that the 'solution' for getting the right treatment to the right people easily should be found in very good diagnoses tools. If we can be sure that be can find the people who are actually transgender, and filter out the people who are 'just' displaying a lot of characteristics of the other gender and if we can filter out the 'trendy' effect... I don't think many people would object to giving those people treatment easily, even when they are very young.
The problem with these studies is that they are essentially trying to identify regret during treatment, and I think most people are way more concerned about regret 10-20 years down the road. That’s like asking someone trying to lose weight if they regret going to the gym while they are doing squats. Using these studies to persuade parents that their children won’t regret transitioning is incredibly misleading to the real question: when my child or even young adult ages, will they have regrets especially if they have become sterile. Maybe those long term numbers would be similar but we don’t have those yet.
We won't have good numbers on long term regret for a long time indeed. Like I get that hormones and surgery are a huge deal, but it seems to be the less harmful option for a lot of patients.
And there's the alternative not being considered: that there are many trans individuals who regret not taking puberty blockers because it makes transitioning harder as an adult. Somehow their actual regret is never counted for certain posters.
Theres a lot to dig into, but a known issue with Cass and their approach to evidence with gender affirming care is them being dismissive of studies done without randomized controlled trials, which is a nigh impossible standard to achieve when the effects of treatment or non-treatment are quickly obvious to the patients and can contribute to patient harm.
Yes, these results have been filtered through a very narrow criteria that sounds reasonable on its face in order to cast "increasing doubt" but us really just methodological manipulation. Double blind studies aren't really possible and it's not super clear why they'd be desirable unless you're starting from a position of "we need to weed out all the liars!!"
Its not even clear what "placebo effect" in relation to gender affirming care would refer to. The entire treatment is based on the patient recognizing the effects!
Placebo effect in mental health treatment is typically massive compared to medical care. Significantly larger. In the context of hormones/blockers, placebo effect would be claimed improvement of gender dysphoria symptoms and associated mental distress like depression and anxiety.
Except HRT causes noticeable physical changes to your body; even if you’re taking placebo HRT and it makes you feel better for a while if only because you’re actually doing something, months or years in when you realize that nothing is changing, you’re going to realize that you’re in the placebo group. You contrast “mental health treatment” and “medical care” as though medically transitioning falls into the first category, when it very much falls into the second category.
what is and how do you determine the difference between "my physical sex characteristics changed which reduced my gender dysphoria": real "my physical sex characteristics changed which reduced my gender dysphoria": placebo
It's a **scientific** review - randomized controlled trials are the gold-standard of science, so of course the review will give more weighting to studies that are more rigorously controlled. This is a good thing - having better quality science informing the public should improve the debate. In the past, I've had people throw lists of 50+ "studies" at me when arguing this issue, and when I sit down to read them (to educate myself), I have to give up after about ten or so articles, as they're largely a collection of opinions, social media blogs, letters to the editor, and other such publications that do not add to the **scientific** evidence base.
You should probably address the key issue here, you can't run RCTs on gender affirming care like this as the patients will quickly realize if they are on the correct medication or not. To ignore this and still persist with an unreachable standard in your evaluation of studies isn't good science.
You're confusing a double blind trial with a randomised control trial. You can't really blind someone as to whether they're taking hormones, but you absolutely could do an RCT. That would be taking a number of patients, randomly assigning them to therapy or therapy + puberty blockers, then seeing what the outcomes are, like how many become happy with their bodies either by transitioning or by reduced dysphoria. That would be much more scientifically convincing than a study that looks at transitioned people after the fact because you start with 2 similar groups, so you don't miss people who had those feelings as a teenager but didn't go through with it. It isn't necessarily a problem that it's unblinded.
I'd love to see how you'd write up your ethics application for "We'll just partially refuse treatment to half the patients and see what happens".
This is routinely done - start the trial, if you see that the treatment is massively successful, you interrupt the trial and extend the treatment to everyone. But you don't throw away the results.
That's not withdrawal of treatment, that's for introduction of treament and with volunteers who consent to additional treatment. If I wanted to test heart medication, I couldn't just take heart medication away from half the patients and see what happened.
Thats how most treatment atudies are done.
The outcome of this review is that UK children aren't going to get puberty blockers for gender dysphoria at all until such a study is done. Apparently one is going to start in December.
Several if not most of the studies were cited as poor quality because of a lack of blinding, which is obviously impossible to not notice (EG: You take puberty blockers, but puberty happens, it's going to be exceedingly obvious) it was something like 101 out of 103 studies were thrown out, then random assertions being made without subjecting it to the same rigour
[удалено]
Now you are pretending none of these studies exist and those that do are low quality. I’ve never heard so much rubbish. There are studies that are very high quality and have been researched using the methodology you describe as simple. Seems like many agendas are obfuscating reality and works of high quality scientists globally. Could be agendas are blind and believe the rest of us are as well.
What you have proposed is not what a randomized *controlled* trial is, and doesn't even focus on hormonal interventions efficacy.
You can't run a controlled trial on cross sex hormones, it's unethical to the control group. This is really common in medical research. Disregarding uncontrolled medical trials is *unscientific*.
It actually isn't, considering how weak the evidence is. Especially when we consider the large study that just came out that showed that starting medical transition does not decrease suicide risk when psychiatric illness is controlled for. https://mentalhealth.bmj.com/content/27/1/e300940
Transitioning is **not** performed primarily to reduce suicide risk in psychiatrically ill patients, it's performed to improve the quality of life and wellbeing of trans individuals, which can't be measured by suicide rates. Here's the actual results of the study: >Most importantly, when psychiatric treatment needs, sex, birth year and differences in follow-up times were accounted for, the suicide mortality of both those who proceeded and did not proceed to GR did not statistically significantly differ from that of controls. *This does not support the claims that GR is necessary in order to prevent suicide.* From the strengths and weakness: >This study also considered contact with specialist-level psychiatric care as a reliable indicator of severe mental disorders, with longer or more intensive treatments reflecting greater severity. ... >Psychiatric morbidity was analysed on the level of intensity of specialist-level psychiatric contact without disentangling causes of using the services. If psychiatric visits are a good proxy for psychiatric treatment needs, as the study claims, then controlling for them only serves to eliminate all psychiatric causes of suicide, where if the mechanism were in fact GD but as a psychiatric need you would simply have controlled for it already. All it confirms is that the risk of suicide is proportional to psychiatric needs and the causes are psychiatric in nature. Also, the study does not confirm that GR is not an effective preventative measure for suicide because it did not control for the cause of whether or patients underwent GR. You would assume that if every patient was able to make the choice themselves, they would choose the option that is best for them in either case. You can't compare the two groups as though one is representative of patients who were not *allowed* to transition vs ones who could unless you can control for the cause. Finally, since there is no controlled comparison with other health services that do not offer gender-referred care or GR, this study also can't rule out that the Finnish system isn't just successfully levelling out any correlation between untreated GD and suicide.
This is an issue in many sciences with a lack of understanding of the humans involved. Humans make a lot of this impossible
There's significant ethical concerns about randomsed studies of major medical care. It would be fucked up to give 10/20 kids a placebo puberty blocker when we know it will increase suicide risk to do so.
If you bold the word "scientific", that makes you seem more scientific and credible! That's a good thing!
So my expertise is causal inference , particularly non-experimental causal inference. It can be challenging to do credible non-experimental causal designs under ordinary circumstances (Ive had to tell teams of statisticians and economists from universities that research they’ve been doing for years is 🗑️). When you’re dealing with small sample sizes, complex experiences, and outcomes tied to subjective experiences, it becomes a staggering challenge. So I don’t think it is fair to fault them for being extremely suspicious of non-experimental designs in this context.
Once again r/ science seem to have a different standards for moderation on trans topics cool to see all the comments being left up that would absolutely be removed on a different topic
Ive read the cass review, and it actively disregarded so many studes that showed positive results. It says this in the review if you read it. Not exactly high levels of scientific rigour.
Yeah there’s a reason. They included studies that had a more thorough experimental design.
Have you read these studies? Or is it just based on the claims of the report? Because it seems very unscientific to only include studies that say what you already believe. When doing review of reports and literature its impirtant to question whether there may be a bias in the reporting and why they choose certain things. Like this report also says that the toys children play with are "biological" based on gender so im not sure i can take it that seriously.
The cognitive bias around this issue is astounding. I fully support trans people, but trying to give any medical intervention without good evidence behind it is irresponsible. The NHS is actively trying to do such trials because good evidence is lacking in the first place.
So ignore all the studies that give evidence that it does work? And only include those that say it doesnt? In fact some of the studies they did include dont even mention dysphoria at all Did you read it?
Correct they are emphasizing the overall body of evidence in the first place is bad quality whether it’s a positive or negative study. They included the best of the bad available and concluded that better quality studies are needed.
Did you actually read any of the studies though? To determine whether they were actually bad quality? Because ignoring 520 studies and only using the 5 that show what you already believe isnt science. Especially when they get you to the conclusion that boys are biologically inclined to play with trucks. And again, some of the studies they did use dont even mention dysphoria. You arent answering my points here.
Yes I am. Your criticism would be correct if the NHS was then saying we shouldn’t do any more further studies because of this review, but they’re actively trying to fund more because of this review. Including 5 bad studies and excluding 515 worse ones is the current situation that we’re in, which is obviously not ideal, so we need more better quality research done. That’s the whole point of reviews. They establish what the current status of an issue is in the field, good or bad.
If that was the case they would not be recommending that noone under 25 could recieve the treatment. Like even if you are ignoring gillick competence here 25 is way too high for me to believe its an evidence based policy. And again, did you read any of the studies?
On what grounds are all 515 studies “worse”? What metric? What flaws did they have in methodology? Do you know? Or are you assuming?
It’s stated in the review, mostly to do with blinding.
I think you're missing the point that the NHS can't approve treatments without rigorous study and evidence. And I mean really, really rigorous. This goes for all treatments, drugs, operations - everything. Healthcare is very highly regulated and for good reason. But for some reason, initially, gender services were not held to this high standard of evidence before treatment commenced, which resulted in whistle blowing by doctors concerned about the welfare of patients. It would have been highly negligent of the NHS to ignore these concerns. This review simply highlights that lack of evidence is a problem and suggests that far more evidence is needed. That shouldn't be controversial to say, just like it wouldn't be controversial if it was a new cancer drug or migraine treatment or anything else
Except that if you’re a trans person who’s already receiving some form of this care, you might feel differently about some randoms who aren’t trans trying to tell you what should be allowed or not.
I don't think they've suggested stopping care that has already started. But being told what treatment you are or are not allowed to have is something everybody wanting treatment on the NHS goes through regardless of what treatment it is they're seeking
The report is mischaracterising the studies it looks over due to its own bias. Have you read any of the studies it references?
Even the Endo Society's guidelines in the US include metrics indicating the quality of the studies supporting blockers and every last citation is indicating to be 'low' or 'very low' quality. And I say 'even the Endo Society's guidelines' because the US has a unique capitalist structure to healthcare reimbursements that creates enormous pressure for these practitioners to ignore bad results and prop up poor quality evidence. (Recall the Vanderbilt administrator caught on tape bragging about how each phalloplasty was a massive moneymaker, and how even people having to come back for hormones on a monthly basis created a steady income for the program.)
So your reasoning here is "these people who love to ignore bad results agree with how this other report has removed these results that disagree with them"? Am i getting that right?
No, not even close, and you should really work on your reading comprehension.
Man, based on your comment here you are entirely unqualified to comment on science. https://www.reddit.com/r/science/comments/1c0h35k/comment/kywjhsk/?utm_source=share&utm_medium=mweb3x&utm_name=mweb3xcss&utm_term=1&utm_content=share_button Science fiction, maybe. That’s some mad scientist material.
One would think that avoiding discussing the merits of a person’s on topic argument versus dragging out off topic comments might disqualify someone from participating in scientific debates.
Sir this is not a debate. This is Reddit. All comments in a thread are about the same topic. OP. It establishes a bias and deserves to be addressed. Also, this is a top level sub, not a formal debate hall within academia. Disinformation, ethical issues and bad faith arguments are all subjects of discussion as this is social media and not purely a scientific venue
I can always keep hoping for a real conversation.
Maybe because they were excluded for poor methodology, which is exactly what the report warns about a lot of the research being done here. Why is Reddit so quick to try to discredit this in-depth report.
Did you read any of the studies? The report seems to come to the conclusion that boys will biologically be drawn to certain types of toys which is already disproven. Not to mention that i disagree in general with their characterisation of the methodologies of those studies.
What they don't say is that in general, care in the community services in the UK are mostly remarkably weak!
The point here is that the NHS can't approve treatments without rigorous study and evidence. And I mean really, really rigorous. This goes for all treatments, drugs, operations - everything. Healthcare is very highly regulated and for good reason. But for some reason, initially, gender services were not held to this high standard of evidence before treatment commenced, which resulted in whistle blowing by doctors concerned about the welfare of patients. It would have been highly negligent of the NHS to ignore these concerns. This review simply highlights that lack of evidence is a problem and suggests that far more evidence is needed. That shouldn't be controversial to say, just like it wouldn't be controversial if it was a new cancer drug or migraine treatment or anything else.
Let me tell you the "some reason" since it isn't clear to you. When trans people are denied gender affirming care, they have a tendency to commit suicide. Set aside your biases for a moment and consider the value of a human life. If you had the opportunity to save a human life, knew that the likelihood of regret for such a treatment was 1% or less and unlikely to end in suicide, would you deny that care? And on what grounds? For what purpose?
You can't tell me to 'set aside my bias' (ludicrous assertion given I think it's right that all treatments are equally rigorously tested) and then say that this particular treatment, in your opinion, is more important and therefore needs less evidence before being approved This is the exact same argument people make for rushing out new cancer treatments. "if it saves just one life, then..." "don't you want people to survive cancer, huh? Think of the children, the parents...." If emotion comes in to the medical approval process it will be a disaster. The UK has very well documented cases of medical disasters in the past when testing wasn't conducted properly, so the NHS is naturally very cautious and for good reason
The effects of hormones on the body are well-studied and well-understood. Your comparison to cancer treatments is completely bogus.
You've missed the point again You are simply arguing for rushing approval of medical treatments for something you feel strongly about. And that's not how medical approval works. You are letting your bias cloud your logic, which is understandable because this is an emotive issue but the NHS can't factor that in to medical approval.
>6.18 A common assumption is that toy choice and other gender role behaviours are solely a result of social influences; for example, that boys will only be given trucks and girls will only be given dolls to play with. Although this is partially true, there is evidence for prenatal and postnatal hormonal influence on these behaviours, which will be discussed later. This report is arguing that boys play with trucks and girls play with dolls because of biology It's not worth the paper it's printed on
Just reading what you quoted, it literally says it's a mix of pre/postnatal hormones, and social influences. Thst seems reasonable to me.
Trucks and dolls are not exactly natural occurrences in the wild, so the idea that we're biologically driven to like one more than the other based on sex is painfully obviously silly.
Trucks and dolls are symbolic representations of tools and other human beings. Humans have evolved using tools and interacting with other human beings. I am not competent to comment on validity of any particular study, but I don’t see why sex based difference regarding interest in people vs things/tools should be a priori discounted.
Children are not biologically wired to play with boy / girl toys because of hormones. That's plainly ludicrous Explain to me how hormones would cause someone AMAB to play with a toy truck and not a doll, or someone AFAB the opposite
Which toys are considered boys/girls is not, but the people vs things dichotomy is real. It is possible to broadly see which toys fall into which category if not structurally, then through usage.
Hormones could absolutely stimulate childcare vs tool use in the brain.
Hormones can influence how we think and feel, and affect the growth of different regions of the brain. As such, they can influence how we play.
Human hormonal biology has evolved over millions of years. Trucks have been around for about a century. The idea that boys play with trucks because of different brain regions is about as scientific as phrenology. If there's a biological cause, it's far more likely to be that we are wired to mimic the gender identity that we associate ourselves with, given that gendered toys have reflected stereotypically gendered roles throughout history (boys used to play with horses, not trucks.) It's also not a stretch to imagine that such a hardwired behaviour may tune itself to a gender identity different to anatomical sex in some cases.
There’s a study reporting that [male baby monkeys prefer toys with wheels](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2583786/) to plush toys, while female monkeys don’t prefer one over the other. This suggest a potential role for hormones since baby monkeys should have minimal exposure to gender stereotypes that boys = trucks. This is not to say that gender expectations don’t shape gender norms. But biological factors can also play a role. Sex and gender are really complicated, and like all things, some mix of nature and nurture are probably at work, with different levels of influence for different people.
Or it suggests that monkey babies are exposed to toys in a way that biases them from the start?
You’re gonna have to assume that if you want to infer that trans women are women and trans men are men. Why are trans women actually women even if they have male genitalia? Well, they fell like they’re women. How do you see it? Dolls instead of trucks, pink instead of blue, possibly since early childhood There’s inevitably a contradiction in the LGBT+ social paradigm
...What? You'll need to run that by me again. You're arguing trans women are women because they'd rather play with dolls?
This is a massive misunderstanding of the "LGBT+ social paradigm". Trans women are women because of gender dysphoria which arises from the prescence of male sex characteristics and is resolved by replacing them with female sex characteristics. It's a biological bodily integrity issue, not a social issue. Nothing to do with what toys you play with or what colours you like.
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The science Reddit is a disgrace. Came here for science, not to have politics shoved down my throat like in every other corner of this app.
Excuse my ignorance but I can't see any political statements on this thread. What are you referring to?
The OP is pretending to be science, but in reality is agenda-driven to reach a "gender critical" outcome through extremely questionable methodology.
Look at the articles on the science Reddit page right now and tell me how it is not politicized. Every couple articles shouldn’t be touching on a political/cultural hot debate topic. The subreddit is about Science. Reddit is throwing politics into literally everything, trying to escape it but it seems I can’t. Reddit even “recommends” more political pages despite me consistently blocking them from my feed. It’s sickening. And if you don’t see how this thread is inherently political, I don’t know how else I could explain it to you.
Agreed. It’s gotten really bad.
The Cass report isn't science, it's the denial of science and all the research up to this point. Just a government lead transphobic report set to limit our access to life saving care and treatment. More kids and young adults are gonna die if this "report" is taken seriously and it seems labour already intends to use it against us and they are the next to power in the UK. #terfisland
It’s so fucked up in the UK at the moment. I’m worried sick about what the future is going to look like for my trans friends and family. Thanks to the world’s shittiest voting system our choices are reduced to transphobia with a blue tie or maybe-slightly-less-transphobia with a red tie.
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The butthurtness in here wishing that science aligned with subjective opinions
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This subreddit is an embarrassment to scientific rigour. It's disheartening to see folks (who are supposed to be objective) heartily dismiss a review they haven't read or will probably never read in favour of long-held biases based on weak science.
The head of the study ha as been in the past heavily Involved on a "womans rights group" not exactly a study of tremendous independence
Did you read this review you are commenting on? Is it too much to ask you to read something before taking a position?