LBGTQ

[Patricio Swayze 17,058]

I have absolutely no idea what you’re babbling about, I’m sorry. 

Of course you don’t.

[Sawbonz 27,087]

48 minutes ago, Poe It Up said:

There’s absolutely risks associated with these drugs, and serious ones. You may think the risk is worth it, but I most certainly do not. Queer, straight, who cares, just leave the kids out of it. 

So if you had a child going through precocious puberty you would refuse them treatment with hormone blockers, and if you had a child with  hypogonadism you would refuse them treatment with hormones?

[hobbes2702 12,714]

7 minutes ago, Sawbonz said:

So if you had a child going through precocious puberty you would refuse them treatment with hormone blockers, and if you had a child with  hypogonadism you would refuse them treatment with hormones?

I love his “just leave the kids out of it”. 
You mean the person seeking treatment? Leave them out of it? How does that work?

[YGIFS 19,445]

9 minutes ago, hobbes2702 said:

I love his “just leave the kids out of it”. 
You mean the person seeking treatment? Leave them out of it? How does that work?

Was it Dr. Oz that said abortion should be between a woman, her doctor, and local political leaders?  at least he had the woman on the list of approved parties.

The trans arguments are like, "Parents and doctors should decide, leave the children out of it!"  It's as ridiculous as PETA sounds to them when they shout "We speak for those who cannot speak for themselves!"  

[Willfully Horn 7,908]

Were progressives as extreme, and as contemptuous of religious freedom, as what poses as conservative these days, they’d be passing laws about the non supportive parents of LBGTQ kids being child abusers, and deserving of jail time. 
 

https://www.metroweekly.com/2022/10/michigan-bill-would-jail-parents-for-allowing-trans-children-to-transition/

https://www.nbcnews.com/news/us-news/idaho-trans-health-care-youth-bill-rcna19287

https://www.reuters.com/world/us/texas-investigating-parents-transgender-youth-child-abuse-2022-03-02/

 

[Poe It Up 126]

42 minutes ago, Sawbonz said:

So if you had a child going through precocious puberty you would refuse them treatment with hormone blockers, and if you had a child with  hypogonadism you would refuse them treatment with hormones?

No, hypogonadism can cause serious medical complications. 

[safe sex 11,620]

Not transitioning can cause death, but whatevs I guess.

[Sawbonz 27,087]

13 minutes ago, Poe It Up said:

No, hypogonadism can cause serious medical complications. 

🤡🤡🤡🤡🤡

[Sawbonz 27,087]

35 minutes ago, safe sex said:

Not transitioning can cause death, but whatevs I guess.

You can lead a horse to water, but you can’t make a moron think

[safe sex 11,620]

According to Poe, suicide is a risk worth taking (see his previous posts in this thread) in order to keep his kids (and by his voting record, the kids of others) from being a big queerdo, but an increased risk of breast cancer or blood clots later in life (as teens are like...the healthiest people on Earth by and large)? Too scary!

Trans Jesus will be the one who sends him to hell eventually.

Edited February 5, 2023 by safe sex

[Bullneck 18,892]

46 minutes ago, Poe It Up said:

No, hypogonadism can cause serious medical complications. 

Abstract

INTRODUCTION

Recent data suggests and increased risk of cardiovascular events and mortality in men on testosterone therapy (TT). To date there are no long term, prospective studies to determine safety. In such cases, retrospective observational studies can be helpful. We examined our patient database to determine if TT altered a man’s risk of all cause mortality.

METHODS

We queried our hormone database for all men with a serum testosterone level and then examined charts to determine testosterone status. In all, 509 men had charts available for review. We linked our patient records to the National Death Index to determine morality.

RESULTS

Of the 509 men who met inclusion criteria, 284 were on testosterone therapy and 225 did not use testosterone. Age (mean 54 years) and follow up time (mean 10 years) were similar for both groups. In all, 19 men died—10 (4.4%) of the men not on TT and 9 (3.2%) of the men on TT. After adjusting for age and year of evaluation, there was no significant difference in the risk of death based on TT (HR 1.0, 95% CI 0.39 – 2.57, p=1.0).

CONCLUSIONS

There appears to be no change in mortality risk overall for men utilizing long-term testosterone therapy.

Keywords: testosterone, hormones, hypogonadism, death

[Bullneck 18,892]

48 minutes ago, Poe It Up said:

No, hypogonadism can cause serious medical complications. 

Women getting Brazilian Butt Lifts can have serious medical complications, too.  Just thought I'd point that out.

I happen to like big butts (and I cannot lie) but if women opt for that enhancement -- or don't-- it's really not up to me.  I don't have a vote as it's not my body.

*******************

BTW, how do you feel about the religious people who don't take their kids to the doctor when they're sick, but rather do a lot of praying about them getting well?  

And while we're at it, what about the people who don't take their kids to the doctor when they're sick, because they're poor?

*******************

I'm assuming you have an opinion on these topics because I just know that your medical opinions are not just limited to trans kids.   

[Patricio Swayze 17,058]

Soon I will be filing formal notice to immamac about a trade with texags. I saw a couple of gay posters over there trying to fight the good fight. I would like to trade some of our wannabe aggy (Anastasia, Poe, Dal and immortal) for their gays. I think everyone would feel more at home. I assume immamac has a red phone that he can pick up and talk to Billy douchi and make it happen.

[Anastasis 23,274]

12 minutes ago, Patricio Swayze said:

Soon I will be filing formal notice to immamac about a trade with texags. I saw a couple of gay posters over there trying to fight the good fight. I would like to trade some of our wannabe aggy (Anastasia, Poe, Dal and immortal) for their gays. I think everyone would feel more at home. I assume immamac has a red phone that he can pick up and talk to Billy douchi and make it happen.

You are going to send a notice to an aggy to eject people with multiple doctorates from UT from a longhorn political forum because they understand evidence grades when discussing drug therapy and you do not.  Good idea guy.  You should run with this.  

[Patricio Swayze 17,058]

You are going to send a notice to an aggy to eject people with multiple doctorates from UT from a longhorn political forum because they understand evidence grades when discussing drug therapy and you do not.  Good idea guy.  You should run with this.  

Lightenupfrancis.gif

Jesus Christ man.

[Anastasis 23,274]

7 minutes ago, Patricio Swayze said:

Lightenupfrancis.gif

Jesus Christ man.

Spider-Manpointing.gif 

[Poe It Up 126]

56 minutes ago, Bullneck said:

Abstract

INTRODUCTION

Recent data suggests and increased risk of cardiovascular events and mortality in men on testosterone therapy (TT). To date there are no long term, prospective studies to determine safety. In such cases, retrospective observational studies can be helpful. We examined our patient database to determine if TT altered a man’s risk of all cause mortality.

METHODS

We queried our hormone database for all men with a serum testosterone level and then examined charts to determine testosterone status. In all, 509 men had charts available for review. We linked our patient records to the National Death Index to determine morality.

RESULTS

Of the 509 men who met inclusion criteria, 284 were on testosterone therapy and 225 did not use testosterone. Age (mean 54 years) and follow up time (mean 10 years) were similar for both groups. In all, 19 men died—10 (4.4%) of the men not on TT and 9 (3.2%) of the men on TT. After adjusting for age and year of evaluation, there was no significant difference in the risk of death based on TT (HR 1.0, 95% CI 0.39 – 2.57, p=1.0).

CONCLUSIONS

There appears to be no change in mortality risk overall for men utilizing long-term testosterone therapy.

Keywords: testosterone, hormones, hypogonadism, death

Yes, I was saying that testosterone therapy was warranted in that situation. 

[Poe It Up 126]

52 minutes ago, Bullneck said:

Women getting Brazilian Butt Lifts can have serious medical complications, too.  Just thought I'd point that out.

I happen to like big butts (and I cannot lie) but if women opt for that enhancement -- or don't-- it's really not up to me.  I don't have a vote as it's not my body.

*******************

BTW, how do you feel about the religious people who don't take their kids to the doctor when they're sick, but rather do a lot of praying about them getting well?  

And while we're at it, what about the people who don't take their kids to the doctor when they're sick, because they're poor?

*******************

I'm assuming you have an opinion on these topics because I just know that your medical opinions are not just limited to trans kids.   

I’d throw those parents in prison. 

[Patricio Swayze 17,058]

Spider-Manpointing.gif 

I’d rather get emotional through love and empathy than hate and ignorance.

[Anastasis 23,274]

5 minutes ago, Patricio Swayze said:

I’d rather get emotional through love and empathy than hate and ignorance.

Emotions are not relevant when it comes to assessing evidence-based medicine. Unless you are aligned to the triplehorn camp. 

Edited February 5, 2023 by Anastasis

[Patricio Swayze 17,058]

Emotions are not relevant when it comes to assessing evidence-based medicine. Unless you are aligned to the triplehorn camp. 

I’m speaking philosophically.

I agree that emotions or faith should not drive decisions.

[TwiceHorn 30,945]

3 hours ago, YGIFS said:

The trans arguments are like, "Parents and doctors should decide, leave the children out of it!"  It's as ridiculous as PETA sounds to them when they shout "We speak for those who cannot speak for themselves!"  

What it implies is that someone other than the child is attempting to make these choices.  That is, "groomers," whatever the fuck that is.

No one has ever said the child should make the choice unfettered by adult guidance.  Everything I see about it refers to children in great psychological distress and very concerned parents and expert medicos trying to help.  Everything I see also indicates that gender affirming car proceeds with due, if not extreme caution with regard it reversibility and drug side effects.

A friend of mine once observed or posed the question, if being gay is a choice, why the fuck would anyone make that choice?  And he meant all the shit gay people have to go through from child and teen angst over being different, to being called names, beaten and sometimes killed, and excluded from all sorts of things like the military, marriages, spousal benefits, and so on and so forth.

Kids may not understand the long term ramifications of various drugs and treatments, but they're not getting those until they're adults.  But kids can surely understand being bullied and ostracized.  Therefore,  any desire to transition has to be driven be a deep-seated discomfort that overcomes the social stigma they are sure to receive, no matter how "woke' you think the libs have turned the kids.

Whether Poe's personal choice for his kids is pro- or anti-transition is a different question than whether Ken fucking Paxton or Greg Abbott or some other fuckstick should be interfering with that decision.

Edited February 5, 2023 by TwiceHorn

[YGIFS 19,445]

Very sensible.  Obviously there are some minors who just want to do this kind of treatment to be defiant, edgy, etc.  

And I do not doubt the scientific prowess of both sides on this thread.  And long-term decisions like this need to come from reason, not emotion.  

But I think of my mother battling cancer for the 2nd time in her 60's in 2009.  She's a fighter and they offered her the chance to take some experimental medication that might prove more effective.  The side effects in the short and medium-term (if there was one) would be far worse than conventional treatments.  Her pain and suffering were such that she didn't care, she chose the experimental meds.  If these young people are made aware and can prove they understand the long-term ramifications of these procedures and drugs and still choose that as an alternative to living every day in a hellish cage of society's creation; unsure if they can make it another week without trying suicide.  That the thought of depression, cancer, mood swings, and fertility issues is outweighed only by the constant and suffocating thought that they are inherently wrong and immoral by their very existence, drugs or no drugs.  Bring in the parents and the doctor and a counselor...everybody else clear the fucking room (looking at you Dan Patrick). 

Texas has millions of people it can pick on and criminalize.  We can let the confused 15-17 year olds sit this round out.  If they regret it later on life, they can join the fucking club.  It's called "Everybody did shit as teens they regret." Club meets at the bar every Friday.  All are welcome, unisex bathrooms.

[safe sex 11,620]

3 minutes ago, YGIFS said:

Very sensible.  Obviously there are some minors who just want to do this kind of treatment to be defiant, edgy, etc.  

I cannot stress enough how much of a thing this isn't.

[DDD Dad 14,133]

1 hour ago, Anastasis said:

Spider-Manpointing.gif 

BOTH SIDES!

[YGIFS 19,445]

4 minutes ago, safe sex said:

I cannot stress enough how much of a thing this isn't.

There's got to be at least two so my statement is factually correct.  I was trying to establish some modicum of appeasement to some other posters.  Two people made a choice for shitty reasons.  It's to prove that just like all these other manufactured issues, we're fucking over 98% of people over somebody else's bullshit.  2 people groomed kids.  2 people attacked women in bathrooms.  2 people forced kids to watch drag shows.  2 teachers actually forced kids to watch drag shows.  The point is we're electing people to engage in sweeping legislation that hurts millions in order to appease a small slice of the electorate over what a handful of people did or didn't do in real life. 

There is a moral component to this, and a scientific component.  But the political component is what's even more disturbing to me.  Yet another group we are going to villlify and hurt because a handful of anecdotal examples got a handful of idiotic voters to cause a fuss.  And like everything else, it hurts the 98% who just want to be left alone.  Like I said in a post awhile back, the best thing right now for everyone on this topic is nothing.  You don't ahve to support trans treatments, yoou don't have to fight it.  Just leave them alone and quit hosting press conferences to blame them for all the evils in children's lives.  

[Brisketexan 104,171]

Oh, in that case, mind your own business, you intrusive, jackbooted prick.

I love the “I’m concerned about parents exposing kids to something I think might be dangerous” bit.
IF Poe was really concerned about parental actions that subject kids to risk (hint: he isn’t), then he would be absolutely UNDONE by the fact that, whatever the number of “transitioning” kids he thinks are being named, 100X more kids are ACTUALLY harmed by the presence of a firearm in the home. That is a proven super-dangerous parental action. Yet…none of his ilk seem troubled by it.
I mean, that COULD be because it’s not about child safety at all, and it’s ACTUALLY about the unrelenting desire of conservatives to control other people.

[Nicole44 21,986]

So when I miscarried a few years ago (I don’t have children) I was having a hard time coping with that and a bad marriage (my ex and I weren’t compatible.) I struggled with alcoholism and anxiety and everything that comes with all of it: shame, guilt etc…I joined a therapy group. Talk about stuff.

It was meant to be just us ladies who’d been through a miscarriage and our hormones and emotions. One of the women in our group had a brother (he was transitioning) and asked because he was dealing with a lot of pain guilt and anxiety and struggling to be a woman if he could join our group. At first, it was a flat no.

But it weighed on the women in in our group a lot. He was suicidal and all that comes along with that. We decided it was okay for him (now her) to join our group. We recognized he was struggling with a lot. I’m absolutely not going to pretend I understand any of this and I have read studies and books about this (we all did so as best to  allow him into our group.) I will tell you it makes absolutely no sense to me whatsoever.  I’m not saying therapy or drugs would help. I’m just saying I don’t get it but I do know people are hurting because this is how they feel. 

this isn’t coming from any place other than love. We did allow him into our group. Out of love so he’d feel safe. I personally don’t want to see someone make a life change (surgery and all of that) until they are fully able to comprehend that it’s irreversible. What I can say, is he fit right into our group at the time. He would never be able to have kids biologically and could empathize with those of us who’d lost one due to miscarriage. I’m not trying to be offensive when I see him as a him and not a her. But what I can say is he is thriving now and married to someone who loves him very much. I mean that’s all that matters. Just my two cents. 

[troph 24,417]

11 hours ago, Anastasis said:

Emotions are not relevant when it comes to assessing evidence-based medicine. Unless you are aligned to the triplehorn camp. 

Even with no money in trans research and active politicalization against it for 8 decades, progress has been made. There is sufficient scientific data to show transition is a legitimate and life improving treatment. To suggest otherwise is an appalling and disgusting continuation of 70+ years of  politicizing and withholding treatment. 

now, if we want to have double blind studies on which methods and which drugs do better with informed consent allowing those patients to opt out and take the standard treatment - you know - current transition treatments, then I’m all in for that.  

Treat it like cancer studies, where everyone is on the same page about finding better treatments and patients can take the traditional treatment route or experimental route but NO ONE is denied treatment because they have cancer. 

what your types want is to stop treatment because “it hasn’t been studied enough.” That’s NOT how the Hippocratic oath works.  Cancer patients get blasted with blunt force trauma radiation even though we are pretty sure new immunotherapy drugs are more promising because those patients aren’t interested in possible placebo risks. Yet what anti-transition proponents want is more time to study before ANY treatment is given. 

fuck that noise. That is harsh discrimination veiled as compassion and it’s disgusting. 

[troph 24,417]

6 hours ago, Nicole44 said:

So when I miscarried a few years ago (I don’t have children) I was having a hard time coping with that and a bad marriage (my ex and I weren’t compatible.) I struggled with alcoholism and anxiety and everything that comes with all of it: shame, guilt etc…I joined a therapy group. Talk about stuff.

It was meant to be just us ladies who’d been through a miscarriage and our hormones and emotions. One of the women in our group had a brother (he was transitioning) and asked because he was dealing with a lot of pain guilt and anxiety and struggling to be a woman if he could join our group. At first, it was a flat no.

But it weighed on the women in in our group a lot. He was suicidal and all that comes along with that. We decided it was okay for him (now her) to join our group. We recognized he was struggling with a lot. I’m absolutely not going to pretend I understand any of this and I have read studies and books about this (we all did so as best to  allow him into our group.) I will tell you it makes absolutely no sense to me whatsoever.  I’m not saying therapy or drugs would help. I’m just saying I don’t get it but I do know people are hurting because this is how they feel. 

this isn’t coming from any place other than love. We did allow him into our group. Out of love so he’d feel safe. I personally don’t want to see someone make a life change (surgery and all of that) until they are fully able to comprehend that it’s irreversible. What I can say, is he fit right into our group at the time. He would never be able to have kids biologically and could empathize with those of us who’d lost one due to miscarriage. I’m not trying to be offensive when I see him as a him and not a her. But what I can say is he is thriving now and married to someone who loves him very much. I mean that’s all that matters. Just my two cents. 

Her? 

[Anastasis 23,274]

1 hour ago, troph said:

There is sufficient scientific data to show transition is a legitimate and life improving treatment. To suggest otherwise is an appalling and disgusting continuation of 70+ years of  politicizing and withholding treatment. 

WRT to hormone therapy in early adolescence this is simply not true.  I think that this type of misinformation does your cause an injustice. And it calls in to my mind a question as to exactly what information is being communicated in the process of obtaining consent from the parent and assent from the child in those cases where hormone treatments are deployed. 

Here are a couple reviews from UK and the Swedish position statement. 

https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_GnRH-analogues_For-upload_Final.pdf

Conclusion

The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.
 

Spoiler

Studies that found differences in outcomes could represent changes that are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance. It is plausible, however, that a lack of difference in scores from baseline to follow-up is the effect of GnRH analogues in children and adolescents with gender dysphoria, in whom the development of secondary sexual characteristics might be expected to be associated with an increased impact on gender dysphoria, depression, anxiety, anger and distress over time without treatment. The study by de Vries et al. 2011 reported statistically significant reductions in the Child Behaviour Checklist (CBCL) and Youth Self-Report (YSR) scores from baseline to follow up, which include measures of distress. As the aim of GnRH analogues is to reduce distress caused by the development of secondary sexual characteristics, this may be an important finding. However, as the studies all lack appropriate controls who were not receiving GnRH analogues, any positive changes could be a regression to mean.

The results of the studies that reported bone density outcomes suggest that GnRH analogues may reduce the expected increase in bone density (which is expected during puberty). However, as the studies themselves are not reliable, the results could be due to confounding, bias or chance. While controlled trials may not be possible, comparative studies are needed to understand this association and whether the effects of GnRH analogues on bone density are seen after they are stopped. All the studies that reported safety outcomes provided very low certainty evidence.

No cost-effectiveness evidence was found to determine whether or not GnRH analogues are cost-effective for children and adolescents with gender dysphoria.

The results of the studies that reported outcomes for subgroups of children and adolescents with gender dysphoria, suggest there may be differences between sex assigned at birth males (transfemales) and sex assigned at birth females (transmales).

 

https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf

Conclusion

This evidence review found limited evidence for the effectiveness and safety of genderaffirming hormones in children and adolescents with gender dysphoria, with all studies being uncontrolled, observational studies, and all outcomes of very low certainty. Any potential benefits of treatment must be weighed against the largely unknown long-term safety profile of these treatments.
 

Spoiler

The results from 5 uncontrolled, observational studies (Achille et al. 2020, Allen et al. 2019, Kaltiala et al. 2020. Kuper et al. 2020, Lopez de Lara et al. 2020) suggest that, in children and adolescents with gender dysphoria, gender-affirming hormones are likely to improve symptoms of gender dysphoria, and may also improve depression, anxiety, quality of life, suicidality, and psychosocial functioning. The impact of treatment on body image is unclear. All results were of very low certainty. The clinical relevance of any improvements to the person is difficult to determine because most outcomes do not have a recognised minimal clinically important difference, and the authors do not present statistical analysis for some outcomes.

A further 5 uncontrolled, observational studies (Khatchadourian et al. 2014, Klaver et al. 2020, Klink et al. 2015, Stoffers et al. 2019 and Vlot et al. 2017) reported on safety outcomes, all of which provided very low certainty evidence. Statistically significant increases in some measures of bone density were seen following treatment with gender-affirming hormones, although results varied by bone region (lumber spine versus femoral neck) and by population (transfemales versus transmales). However, z-scores suggest that bone density remained lower in transfemales and transmales compared with an equivalent cisgender population. Results from 1 study of gender-affirming hormones started during adolescence reported statistically significant increases in blood pressure and body mass index, and worsening of the lipid profile (in transmales) at age 22 years, although longer term studies that report on cardiovascular event rates are needed. Adverse events and discontinuation rates associated with gender-affirming hormones were only reported in 1 study, and no conclusions can be made on these outcomes.

This review did not identify sub-groups of people who may benefit more from genderaffirming hormones. Limited evidence from 2 studies suggests there was no difference in This document was prepared in October 2020 Page 51 of 156 response to treatment between transfemales and transmales for mental health and quality of life (Achille et al. 2020 and Allen et al. 2019).

No cost-effectiveness evidence was found to determine whether gender-affirming hormones are a cost-effective treatment for children and adolescents with gender dysphoria.

 

https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdf

For adolescents with gender incongruence, the NBHW deems that the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases. This judgement is based mainly on three factors: the continued lack of reliable scientific evidence concerning the efficacy and the safety of both treatments [2], the new knowledge that detransition occurs among young adults [3], and the uncertainty that follows from the yet unexplained increase in the number of care seekers, an increase particularly large among adolescents registered as females at birth [4].
 

Spoiler

A systematic review published in 2022 by the Swedish Agency for Health Technology Assessment and Assessment of Social Services [2] shows that the state of knowledge largely remains unchanged compared to 2015. High quality trials such as RCTs are still lacking and the evidence on treatment efficacy and safety is still insufficient and inconclusive for all reported outcomes. Further, it is not possible to determine how common it is for adolescents who undergo gender-affirming treatment to later change their perception of their gender identity or interrupt an ongoing treatment. An important difference compared to 2015 however, is that the occurrence of CARE OF CHILDREN AND ADOLESCENTS WITH GENDER DYSPHORIA SOCIALSTYRELSEN 3detransition among young adults is now documented [3], meaning that the uncertain evidence that indicates a low prevalence of treatment interruptions or any aspects of regret is no longer unchallenged. Although the prevalence of detransition is still unknown, the knowledge that it occurs and that genderconfirming treatment thus may lead to a deteriorating of health and quality of life (i.e. harm), is important for the overall judgement and recommendation.

To minimize the risk that a young person with gender incongruence later will regret a gender-affirming treatment, the NBHW deems that the criteria for offering GnRH-analogue and gender-affirming hormones should link more closely to those used in the Dutch protocol, where the duration of gender incongruence over time is emphasized [5-7]. Accordingly, an early (childhood) onset of gender incongruence, persistence of gender incongruence until puberty and a marked psychological strain in response to pubertal development is among the recommended criteria. The publications that describe these criteria and the treatment outcomes when given in accordance [5, 6, 8] consitute the best available knowledge and should be used as guidance.

To ensure that new knowledge is gathered, the NBHW further deems that treatment with GnRH-analogues and sex hormones for young people should be provided within a research context, which does not necessarily imply the use of randomized controlled trials (RCTs). As in other healthcare areas where it is difficult to conduct RCTs while retaining sufficient internal validity, it is also important that other prospective study designs are considered for ethical review and that register studies are made possible. Until a research study is in place, the NBHW deems that treatment with GnRH-analogues and sex hormones may be given in exceptional cases, in accordance with the updated recommendations and criteria described in the guidelines. The complex multidisciplinary assessments will eventually be carried out in the three national units that are granted permission to provide highly specialized care services.

In accordance with the DSM-5, the recommendations in the guidelines from 2015 applied to young people with gender dysphoria in general, i.e. also young people with a non-binary gender identity. Another criterion within the Dutch protocol is that the child has had a binary (“cross-gender”) gender identity since childhood [5, 6]. 4 CARE OF CHILDREN AND ADOLESCENTS WITH GENDER DYSPHORIA SOCIALSTYRELSENIt has emerged during the review process, that the clinical experience and documentation of puberty-suppressing and hormonal treatment for young people with non-binary gender identity is lacking, and also that it is limited for adults. The NBHW still considers that gender dysphoria rather than gender identity should determine access to care and treatment. An urgent work thus remains, to clarify criteria under which adolescents with non-binary gender identity may be offered puberty-suppressing and gender-affirming hormonal treatment within a research framework.

 

 

1 hour ago, troph said:

now, if we want to have double blind studies on which methods and which drugs do better with informed consent allowing those patients to opt out and take the standard treatment - you know - current transition treatments, then I’m all in for that.  

Yes, generating appropriate evidence is necessary. I think that controlled studies are more important in this setting than blinding, but that is getting into the weeds. That position which we share regarding the need for quality research is echoed in the Swedish position statement quoted above. The use of gnrh and hormone supplementation needs to be examined within a research framework. You don't just start calling it the "standard of care" or "standard treatment" without compelling evidence. Thinking like that ends up with desperate people sucking horse paste out of a tube they picked up at Tractor Supply. 

1 hour ago, troph said:

Treat it like cancer studies, where everyone is on the same page about finding better treatments and patients can take the traditional treatment route or experimental route but NO ONE is denied treatment because they have cancer. 

what your types want is to stop treatment because “it hasn’t been studied enough.” That’s NOT how the Hippocratic oath works.  Cancer patients get blasted with blunt force trauma radiation even though we are pretty sure new immunotherapy drugs are more promising because those patients aren’t interested in possible placebo risks. Yet what anti-transition proponents want is more time to study before ANY treatment is given. 

I don't think that the research approach used in terminal oncology cases is an appropriate research framework here. But there are ways that controlled trials can be conducted ethically in this setting.

 

 

 

[Nicole44 21,986]

1 hour ago, troph said:

Her? 

Kinda confusing for me. He made the transition to female. Lived that way for two years and now identifies as male and wants to be called a he so…just going along for the ride. 

[Sawbonz 27,087]

I think it is almost impossible to conduct a well designed appropriately powered study to test the efficacy of puberty delaying or gender affirming hormone treatment for gender dysphoria. There is so much psychological and socionormative overlay in play that measuring positive or negative effects of pharmacotherapy would be very difficult IMO. I would imagine a child with supportive parents, siblings and peers, but who had no access to pharmacotherapy and mental health care, would score higher on outcomes measures than one who had full access to pharmacotherapy and psychotherapy but had a parent or sibling who thought they were a freak or going to hell, or a peer group that delighted in picking on them. Throw in normal pre-teen and teen stressors and mental illnesses that can also be comorbidities. It’s a complex situation  

 

We have > 30 years of data on the safety of these medications when used for precocious puberty and hypogonadism however, and I cannot think of a medical reason to suspect the use of these medications in children for gender dysphoria would be any less safe than in these other kids. 
 

and ultimately use in the precocious puberty and hypogonadism populations was initiated in order to help them look and feel “normal”. I don’t think anyone would argue those treatments are controversial or likely to be ineffective in these populations so why so controversial for gender dysphoria?

[hayden_horn 11,348]

28 minutes ago, Sawbonz said:

I think it is almost impossible to conduct a well designed appropriately powered study to test the efficacy of puberty delaying or gender affirming hormone treatment for gender dysphoria. There is so much psychological and socionormative overlay in play that measuring positive or negative effects of pharmacotherapy would be very difficult IMO. I would imagine a child with supportive parents, siblings and peers, but who had no access to pharmacotherapy and mental health care, would score higher on outcomes measures than one who had full access to pharmacotherapy and psychotherapy but had a parent or sibling who thought they were a freak or going to hell, or a peer group that delighted in picking on them. Throw in normal pre-teen and teen stressors and mental illnesses that can also be comorbidities. It’s a complex situation  

 

We have > 30 years of data on the safety of these medications when used for precocious puberty and hypogonadism however, and I cannot think of a medical reason to suspect the use of these medications in children for gender dysphoria would be any less safe than in these other kids. 
 

and ultimately use in the precocious puberty and hypogonadism populations was initiated in order to help them look and feel “normal”. I don’t think anyone would argue those treatments are controversial or likely to be ineffective in these populations so why so controversial for gender dysphoria?

it's pretty much in the term normal. 

people are generally dismissive or deride things that make them uncomfortable. 

so they revert to their version of normal. it's not about the patient feeling normal or better. 

[Poe It Up 126]

34 minutes ago, Sawbonz said:

I think it is almost impossible to conduct a well designed appropriately powered study to test the efficacy of puberty delaying or gender affirming hormone treatment for gender dysphoria. There is so much psychological and socionormative overlay in play that measuring positive or negative effects of pharmacotherapy would be very difficult IMO. I would imagine a child with supportive parents, siblings and peers, but who had no access to pharmacotherapy and mental health care, would score higher on outcomes measures than one who had full access to pharmacotherapy and psychotherapy but had a parent or sibling who thought they were a freak or going to hell, or a peer group that delighted in picking on them. Throw in normal pre-teen and teen stressors and mental illnesses that can also be comorbidities. It’s a complex situation  

 

We have > 30 years of data on the safety of these medications when used for precocious puberty and hypogonadism however, and I cannot think of a medical reason to suspect the use of these medications in children for gender dysphoria would be any less safe than in these other kids. 
 

and ultimately use in the precocious puberty and hypogonadism populations was initiated in order to help them look and feel “normal”. I don’t think anyone would argue those treatments are controversial or likely to be ineffective in these populations so why so controversial for gender dysphoria?

The situations are very different in that if hypogonadism is left untreated, you’re looking at a lifetime of serious medical issues. 

[Poe It Up 126]

2 hours ago, Anastasis said:

WRT to hormone therapy in early adolescence this is simply not true.  I think that this type of misinformation does your cause an injustice. And it calls in to my mind a question as to exactly what information is being communicated in the process of obtaining consent from the parent and assent from the child in those cases where hormone treatments are deployed. 

Here are a couple reviews from UK and the Swedish position statement. 

https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_GnRH-analogues_For-upload_Final.pdf

Conclusion

The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.
 

  Reveal hidden contents

Studies that found differences in outcomes could represent changes that are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance. It is plausible, however, that a lack of difference in scores from baseline to follow-up is the effect of GnRH analogues in children and adolescents with gender dysphoria, in whom the development of secondary sexual characteristics might be expected to be associated with an increased impact on gender dysphoria, depression, anxiety, anger and distress over time without treatment. The study by de Vries et al. 2011 reported statistically significant reductions in the Child Behaviour Checklist (CBCL) and Youth Self-Report (YSR) scores from baseline to follow up, which include measures of distress. As the aim of GnRH analogues is to reduce distress caused by the development of secondary sexual characteristics, this may be an important finding. However, as the studies all lack appropriate controls who were not receiving GnRH analogues, any positive changes could be a regression to mean.

The results of the studies that reported bone density outcomes suggest that GnRH analogues may reduce the expected increase in bone density (which is expected during puberty). However, as the studies themselves are not reliable, the results could be due to confounding, bias or chance. While controlled trials may not be possible, comparative studies are needed to understand this association and whether the effects of GnRH analogues on bone density are seen after they are stopped. All the studies that reported safety outcomes provided very low certainty evidence.

No cost-effectiveness evidence was found to determine whether or not GnRH analogues are cost-effective for children and adolescents with gender dysphoria.

The results of the studies that reported outcomes for subgroups of children and adolescents with gender dysphoria, suggest there may be differences between sex assigned at birth males (transfemales) and sex assigned at birth females (transmales).

 

https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf

Conclusion

This evidence review found limited evidence for the effectiveness and safety of genderaffirming hormones in children and adolescents with gender dysphoria, with all studies being uncontrolled, observational studies, and all outcomes of very low certainty. Any potential benefits of treatment must be weighed against the largely unknown long-term safety profile of these treatments.
 

  Reveal hidden contents

The results from 5 uncontrolled, observational studies (Achille et al. 2020, Allen et al. 2019, Kaltiala et al. 2020. Kuper et al. 2020, Lopez de Lara et al. 2020) suggest that, in children and adolescents with gender dysphoria, gender-affirming hormones are likely to improve symptoms of gender dysphoria, and may also improve depression, anxiety, quality of life, suicidality, and psychosocial functioning. The impact of treatment on body image is unclear. All results were of very low certainty. The clinical relevance of any improvements to the person is difficult to determine because most outcomes do not have a recognised minimal clinically important difference, and the authors do not present statistical analysis for some outcomes.

A further 5 uncontrolled, observational studies (Khatchadourian et al. 2014, Klaver et al. 2020, Klink et al. 2015, Stoffers et al. 2019 and Vlot et al. 2017) reported on safety outcomes, all of which provided very low certainty evidence. Statistically significant increases in some measures of bone density were seen following treatment with gender-affirming hormones, although results varied by bone region (lumber spine versus femoral neck) and by population (transfemales versus transmales). However, z-scores suggest that bone density remained lower in transfemales and transmales compared with an equivalent cisgender population. Results from 1 study of gender-affirming hormones started during adolescence reported statistically significant increases in blood pressure and body mass index, and worsening of the lipid profile (in transmales) at age 22 years, although longer term studies that report on cardiovascular event rates are needed. Adverse events and discontinuation rates associated with gender-affirming hormones were only reported in 1 study, and no conclusions can be made on these outcomes.

This review did not identify sub-groups of people who may benefit more from genderaffirming hormones. Limited evidence from 2 studies suggests there was no difference in This document was prepared in October 2020 Page 51 of 156 response to treatment between transfemales and transmales for mental health and quality of life (Achille et al. 2020 and Allen et al. 2019).

No cost-effectiveness evidence was found to determine whether gender-affirming hormones are a cost-effective treatment for children and adolescents with gender dysphoria.

 

https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdf

For adolescents with gender incongruence, the NBHW deems that the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases. This judgement is based mainly on three factors: the continued lack of reliable scientific evidence concerning the efficacy and the safety of both treatments [2], the new knowledge that detransition occurs among young adults [3], and the uncertainty that follows from the yet unexplained increase in the number of care seekers, an increase particularly large among adolescents registered as females at birth [4].
 

  Reveal hidden contents

A systematic review published in 2022 by the Swedish Agency for Health Technology Assessment and Assessment of Social Services [2] shows that the state of knowledge largely remains unchanged compared to 2015. High quality trials such as RCTs are still lacking and the evidence on treatment efficacy and safety is still insufficient and inconclusive for all reported outcomes. Further, it is not possible to determine how common it is for adolescents who undergo gender-affirming treatment to later change their perception of their gender identity or interrupt an ongoing treatment. An important difference compared to 2015 however, is that the occurrence of CARE OF CHILDREN AND ADOLESCENTS WITH GENDER DYSPHORIA SOCIALSTYRELSEN 3detransition among young adults is now documented [3], meaning that the uncertain evidence that indicates a low prevalence of treatment interruptions or any aspects of regret is no longer unchallenged. Although the prevalence of detransition is still unknown, the knowledge that it occurs and that genderconfirming treatment thus may lead to a deteriorating of health and quality of life (i.e. harm), is important for the overall judgement and recommendation.

To minimize the risk that a young person with gender incongruence later will regret a gender-affirming treatment, the NBHW deems that the criteria for offering GnRH-analogue and gender-affirming hormones should link more closely to those used in the Dutch protocol, where the duration of gender incongruence over time is emphasized [5-7]. Accordingly, an early (childhood) onset of gender incongruence, persistence of gender incongruence until puberty and a marked psychological strain in response to pubertal development is among the recommended criteria. The publications that describe these criteria and the treatment outcomes when given in accordance [5, 6, 8] consitute the best available knowledge and should be used as guidance.

To ensure that new knowledge is gathered, the NBHW further deems that treatment with GnRH-analogues and sex hormones for young people should be provided within a research context, which does not necessarily imply the use of randomized controlled trials (RCTs). As in other healthcare areas where it is difficult to conduct RCTs while retaining sufficient internal validity, it is also important that other prospective study designs are considered for ethical review and that register studies are made possible. Until a research study is in place, the NBHW deems that treatment with GnRH-analogues and sex hormones may be given in exceptional cases, in accordance with the updated recommendations and criteria described in the guidelines. The complex multidisciplinary assessments will eventually be carried out in the three national units that are granted permission to provide highly specialized care services.

In accordance with the DSM-5, the recommendations in the guidelines from 2015 applied to young people with gender dysphoria in general, i.e. also young people with a non-binary gender identity. Another criterion within the Dutch protocol is that the child has had a binary (“cross-gender”) gender identity since childhood [5, 6]. 4 CARE OF CHILDREN AND ADOLESCENTS WITH GENDER DYSPHORIA SOCIALSTYRELSENIt has emerged during the review process, that the clinical experience and documentation of puberty-suppressing and hormonal treatment for young people with non-binary gender identity is lacking, and also that it is limited for adults. The NBHW still considers that gender dysphoria rather than gender identity should determine access to care and treatment. An urgent work thus remains, to clarify criteria under which adolescents with non-binary gender identity may be offered puberty-suppressing and gender-affirming hormonal treatment within a research framework.

 

 

Yes, generating appropriate evidence is necessary. I think that controlled studies are more important in this setting than blinding, but that is getting into the weeds. That position which we share regarding the need for quality research is echoed in the Swedish position statement quoted above. The use of gnrh and hormone supplementation needs to be examined within a research framework. You don't just start calling it the "standard of care" or "standard treatment" without compelling evidence. Thinking like that ends up with desperate people sucking horse paste out of a tube they picked up at Tractor Supply. 

I don't think that the research approach used in terminal oncology cases is an appropriate research framework here. But there are ways that controlled trials can be conducted ethically in this setting.

 

 

 

Thanks for the info, there’s a lot to digest there. 

[troph 24,417]

2 hours ago, Nicole44 said:

Kinda confusing for me. He made the transition to female. Lived that way for two years and now identifies as male and wants to be called a he so…just going along for the ride. 

Fair enough. 

[TwiceHorn 30,945]

11 hours ago, Nicole44 said:

I’m absolutely not going to pretend I understand any of this and I have read studies and books about this (we all did so as best to  allow him into our group.) I will tell you it makes absolutely no sense to me whatsoever.  I’m not saying therapy or drugs would help. I’m just saying I don’t get it but I do know people are hurting because this is how they feel. 

This is so important an aspect of this to me.  No, I don't understand it and can't really comprehend it beyond understanding that it involves some level of human suffering.

There was a time in my life where I then would have been dismissive of it as lunacy or some such.  But particularly as right-wingers try to make some combination joke and policy statement/position out of it, I think it's super-important to keep an open mind on the subject and give the people going through this some or complete benefit of the doubt that what they're experiencing is real and deeply troubling to them.  

Troph certainly helped humanize the whole thing for me.

And now that I am forced to fact-check virtually everything coming from the right, I have fact-checked this whole transitioning thing and found it to be pretty much a nothingburger in terms of people forcing or letting minors do something highly inadvisable and irreversible on some kind of socially created whim.  There's a lot of roadblocks and off-ramps for this if the sufferer decides or needs to take them.

Once the sufferer is an adult, there are quite a few things that are less reversible and maybe even have long-term health consequences that have to be balanced against notions of happiness, contentment, and sanity.  But I can't imagine that anyone really wants to legally intervene in that.

Edited February 5, 2023 by TwiceHorn

[troph 24,417]

2 hours ago, Anastasis said:

WRT to hormone therapy in early adolescence this is simply not true.  I think that this type of misinformation does your cause an injustice. And it calls in to my mind a question as to exactly what information is being communicated in the process of obtaining consent from the parent and assent from the child in those cases where hormone treatments are deployed. 

Here are a couple reviews from UK and the Swedish position statement. 

https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_GnRH-analogues_For-upload_Final.pdf

Conclusion

The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.
 

  Reveal hidden contents

Studies that found differences in outcomes could represent changes that are either of questionable clinical value, or the studies themselves are not reliable and changes could be due to confounding, bias or chance. It is plausible, however, that a lack of difference in scores from baseline to follow-up is the effect of GnRH analogues in children and adolescents with gender dysphoria, in whom the development of secondary sexual characteristics might be expected to be associated with an increased impact on gender dysphoria, depression, anxiety, anger and distress over time without treatment. The study by de Vries et al. 2011 reported statistically significant reductions in the Child Behaviour Checklist (CBCL) and Youth Self-Report (YSR) scores from baseline to follow up, which include measures of distress. As the aim of GnRH analogues is to reduce distress caused by the development of secondary sexual characteristics, this may be an important finding. However, as the studies all lack appropriate controls who were not receiving GnRH analogues, any positive changes could be a regression to mean.

The results of the studies that reported bone density outcomes suggest that GnRH analogues may reduce the expected increase in bone density (which is expected during puberty). However, as the studies themselves are not reliable, the results could be due to confounding, bias or chance. While controlled trials may not be possible, comparative studies are needed to understand this association and whether the effects of GnRH analogues on bone density are seen after they are stopped. All the studies that reported safety outcomes provided very low certainty evidence.

No cost-effectiveness evidence was found to determine whether or not GnRH analogues are cost-effective for children and adolescents with gender dysphoria.

The results of the studies that reported outcomes for subgroups of children and adolescents with gender dysphoria, suggest there may be differences between sex assigned at birth males (transfemales) and sex assigned at birth females (transmales).

 

https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf

Conclusion

This evidence review found limited evidence for the effectiveness and safety of genderaffirming hormones in children and adolescents with gender dysphoria, with all studies being uncontrolled, observational studies, and all outcomes of very low certainty. Any potential benefits of treatment must be weighed against the largely unknown long-term safety profile of these treatments.
 

  Reveal hidden contents

The results from 5 uncontrolled, observational studies (Achille et al. 2020, Allen et al. 2019, Kaltiala et al. 2020. Kuper et al. 2020, Lopez de Lara et al. 2020) suggest that, in children and adolescents with gender dysphoria, gender-affirming hormones are likely to improve symptoms of gender dysphoria, and may also improve depression, anxiety, quality of life, suicidality, and psychosocial functioning. The impact of treatment on body image is unclear. All results were of very low certainty. The clinical relevance of any improvements to the person is difficult to determine because most outcomes do not have a recognised minimal clinically important difference, and the authors do not present statistical analysis for some outcomes.

A further 5 uncontrolled, observational studies (Khatchadourian et al. 2014, Klaver et al. 2020, Klink et al. 2015, Stoffers et al. 2019 and Vlot et al. 2017) reported on safety outcomes, all of which provided very low certainty evidence. Statistically significant increases in some measures of bone density were seen following treatment with gender-affirming hormones, although results varied by bone region (lumber spine versus femoral neck) and by population (transfemales versus transmales). However, z-scores suggest that bone density remained lower in transfemales and transmales compared with an equivalent cisgender population. Results from 1 study of gender-affirming hormones started during adolescence reported statistically significant increases in blood pressure and body mass index, and worsening of the lipid profile (in transmales) at age 22 years, although longer term studies that report on cardiovascular event rates are needed. Adverse events and discontinuation rates associated with gender-affirming hormones were only reported in 1 study, and no conclusions can be made on these outcomes.

This review did not identify sub-groups of people who may benefit more from genderaffirming hormones. Limited evidence from 2 studies suggests there was no difference in This document was prepared in October 2020 Page 51 of 156 response to treatment between transfemales and transmales for mental health and quality of life (Achille et al. 2020 and Allen et al. 2019).

No cost-effectiveness evidence was found to determine whether gender-affirming hormones are a cost-effective treatment for children and adolescents with gender dysphoria.

 

https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/kunskapsstod/2022-3-7799.pdf

For adolescents with gender incongruence, the NBHW deems that the risks of puberty suppressing treatment with GnRH-analogues and gender-affirming hormonal treatment currently outweigh the possible benefits, and that the treatments should be offered only in exceptional cases. This judgement is based mainly on three factors: the continued lack of reliable scientific evidence concerning the efficacy and the safety of both treatments [2], the new knowledge that detransition occurs among young adults [3], and the uncertainty that follows from the yet unexplained increase in the number of care seekers, an increase particularly large among adolescents registered as females at birth [4].
 

  Reveal hidden contents

A systematic review published in 2022 by the Swedish Agency for Health Technology Assessment and Assessment of Social Services [2] shows that the state of knowledge largely remains unchanged compared to 2015. High quality trials such as RCTs are still lacking and the evidence on treatment efficacy and safety is still insufficient and inconclusive for all reported outcomes. Further, it is not possible to determine how common it is for adolescents who undergo gender-affirming treatment to later change their perception of their gender identity or interrupt an ongoing treatment. An important difference compared to 2015 however, is that the occurrence of CARE OF CHILDREN AND ADOLESCENTS WITH GENDER DYSPHORIA SOCIALSTYRELSEN 3detransition among young adults is now documented [3], meaning that the uncertain evidence that indicates a low prevalence of treatment interruptions or any aspects of regret is no longer unchallenged. Although the prevalence of detransition is still unknown, the knowledge that it occurs and that genderconfirming treatment thus may lead to a deteriorating of health and quality of life (i.e. harm), is important for the overall judgement and recommendation.

To minimize the risk that a young person with gender incongruence later will regret a gender-affirming treatment, the NBHW deems that the criteria for offering GnRH-analogue and gender-affirming hormones should link more closely to those used in the Dutch protocol, where the duration of gender incongruence over time is emphasized [5-7]. Accordingly, an early (childhood) onset of gender incongruence, persistence of gender incongruence until puberty and a marked psychological strain in response to pubertal development is among the recommended criteria. The publications that describe these criteria and the treatment outcomes when given in accordance [5, 6, 8] consitute the best available knowledge and should be used as guidance.

To ensure that new knowledge is gathered, the NBHW further deems that treatment with GnRH-analogues and sex hormones for young people should be provided within a research context, which does not necessarily imply the use of randomized controlled trials (RCTs). As in other healthcare areas where it is difficult to conduct RCTs while retaining sufficient internal validity, it is also important that other prospective study designs are considered for ethical review and that register studies are made possible. Until a research study is in place, the NBHW deems that treatment with GnRH-analogues and sex hormones may be given in exceptional cases, in accordance with the updated recommendations and criteria described in the guidelines. The complex multidisciplinary assessments will eventually be carried out in the three national units that are granted permission to provide highly specialized care services.

In accordance with the DSM-5, the recommendations in the guidelines from 2015 applied to young people with gender dysphoria in general, i.e. also young people with a non-binary gender identity. Another criterion within the Dutch protocol is that the child has had a binary (“cross-gender”) gender identity since childhood [5, 6]. 4 CARE OF CHILDREN AND ADOLESCENTS WITH GENDER DYSPHORIA SOCIALSTYRELSENIt has emerged during the review process, that the clinical experience and documentation of puberty-suppressing and hormonal treatment for young people with non-binary gender identity is lacking, and also that it is limited for adults. The NBHW still considers that gender dysphoria rather than gender identity should determine access to care and treatment. An urgent work thus remains, to clarify criteria under which adolescents with non-binary gender identity may be offered puberty-suppressing and gender-affirming hormonal treatment within a research framework.

 

 

Yes, generating appropriate evidence is necessary. I think that controlled studies are more important in this setting than blinding, but that is getting into the weeds. That position which we share regarding the need for quality research is echoed in the Swedish position statement quoted above. The use of gnrh and hormone supplementation needs to be examined within a research framework. You don't just start calling it the "standard of care" or "standard treatment" without compelling evidence. Thinking like that ends up with desperate people sucking horse paste out of a tube they picked up at Tractor Supply. 

I don't think that the research approach used in terminal oncology cases is an appropriate research framework here. But there are ways that controlled trials can be conducted ethically in this setting.

 

 

 

The only issue raised in your post is proper diagnosis not effectiveness of treatment. You still seem to advocate - without saying it - that no treatment should be given until we know more.  That’s just beyond inappropriate for the trans community.  Continue to work on diagnosis protocols for youth and refining standards of care for youth should be everyone’s desire and it’s what doctors do - evolve the standard of care and diagnosis protocols, the problem is the duplicitous conservatives hide behind that in their calls for prohibition. If this wasn’t politicized we could actually make some progress, but our community has done without that for 70 years and even now facing major headwinds with permabans and jail time threatened. 
 

so in that backdrop understand you do not sound like a concerned professional, you sound like a person who is uncomfortable with others seeking treatment and are hiding behind your education and professionalism to do what people have done for decades, block treatment.

[troph 24,417]

5 minutes ago, TwiceHorn said:

This is so important an aspect of this to me.  No, I don't understand it and can't really comprehend it beyond understanding that it involves some level of human suffering.

There was a time in my life where I then would have been dismissive of it as lunacy or some such.  But particularly as right-wingers try to make some combination joke and policy statement/position out of it, I think it's super-important to keep an open mind on the subject and give the people going through this some or complete benefit of the doubt that what they're experiencing is real and deeply troubling to them.  

Troph certainly helped humanize the whole thing for me.

And now that I am forced to fact-check virtually everything coming from the right, I have fact-checked this whole transitioning thing and found it to be pretty much a nothingburger in terms of people forcing or letting minors do something highly inadvisable and irreversible on some kind of socially created whim.  There's a lot of roadblocks and off-ramps for this if the sufferer decides or needs to take them.

Once the sufferer is an adult, there are quite a few things that are less reversible and maybe even have long-term health consequences that have to be balanced against notions of happiness, contentment, and sanity.  But I can't imagine that anyone really wants to legally intervene in that.

Thank you. 
 

I do think they want to legally intervene in adult decisions in states like Texas and Florida though. They know they won’t have the support but trial balloons are floated often. It’s very much on their list. Hell Texas already has a proposed law that state funded insurance won’t pay for treatment of any trans person. It’s just ludicrous. 
 

 

[TwiceHorn 30,945]

1 minute ago, troph said:

Thank you. 
 

I do think they want to legally intervene in adult decisions in states like Texas and Florida though. They know they won’t have the support but trial balloons are floated often. It’s very much on their list. Hell Texas already has a proposed law that state funded insurance won’t pay for treatment of any trans person. It’s just ludicrous. 
 

 

Well, one thing in Texas is that there's barely any state-funded insurance to speak of, so it's probably not a real big issue.  

(That's a bit tongue-in-cheek).

I do have to say that I am not sure I am 100% opposed to limitations on government funding of this for prison inmates, for a couple of reasons.  For one thing, I'm not sure as inmates that they're getting the top-flight diagnoses and treatments from prison docs, and I also fear that there may be an attempt to manipulate the system as by cis-males trying to get to women's prisons where they have a/c and other "benefits."  Of course, surgical transition is a mighty extreme way to make prison "more fun."  And the whole timing issue of having it done "inside" or "outside." That's a tough one.

[Willfully Horn 7,908]

Coincidence?
 

Right-wing nationalism comes to ... Sweden?

https://chicago.suntimes.com/columnists/2022/9/21/23364936/right-wing-nationalism-sweden-fascism-democracy-column-se-cupp
 

 

[Willfully Horn 7,908]

2 hours ago, Sawbonz said:

I think it is almost impossible to conduct a well designed appropriately powered study to test the efficacy of puberty delaying or gender affirming hormone treatment for gender dysphoria. There is so much psychological and socionormative overlay in play that measuring positive or negative effects of pharmacotherapy would be very difficult IMO. I would imagine a child with supportive parents, siblings and peers, but who had no access to pharmacotherapy and mental health care, would score higher on outcomes measures than one who had full access to pharmacotherapy and psychotherapy but had a parent or sibling who thought they were a freak or going to hell, or a peer group that delighted in picking on them. Throw in normal pre-teen and teen stressors and mental illnesses that can also be comorbidities. It’s a complex situation  

 

We have > 30 years of data on the safety of these medications when used for precocious puberty and hypogonadism however, and I cannot think of a medical reason to suspect the use of these medications in children for gender dysphoria would be any less safe than in these other kids. 
 

and ultimately use in the precocious puberty and hypogonadism populations was initiated in order to help them look and feel “normal”. I don’t think anyone would argue those treatments are controversial or likely to be ineffective in these populations so why so controversial for gender dysphoria?

This Dutch study examines the issues you raise regarding stigmatization affecting quality of life post transition. This was a small study, comprised of 20 individuals, ten trans men and ten trans women.

Notably, and I will have to summarize as the format does not copy and paste easily, in that all the participants reported feeling happier psychologically, post transition. They were less depressed, had more peace of mind, and fewer suicidal thoughts. And, the more support and acceptance they received, the more lasting these improvements were.

Their headwinds came at the blowback of a segment of society. Almost as if stigmatization makes human beings depressed, steals one’s peace of mind, and can lead to despondency.  So, the mental improvements gained were abraded over time by the blowhards of intolerance.

 

https://www.researchgate.net/publication/340678902_Experiences_with_stigmatization_among_transgender_individuals_after_transition_A_qualitative_study_in_the_Netherlands

 

Edited February 5, 2023 by Willfully Horn
Edit

[Anastasis 23,274]

16 minutes ago, Sawbonz said:

I think it is almost impossible to conduct a well designed appropriately powered study to test the efficacy of puberty delaying or gender affirming hormone treatment for gender dysphoria. There is so much psychological and socionormative overlay in play that measuring positive or negative effects of pharmacotherapy would be very difficult IMO. I would imagine a child with supportive parents, siblings and peers, but who had no access to pharmacotherapy and mental health care, would score higher on outcomes measures than one who had full access to pharmacotherapy and psychotherapy but had a parent or sibling who thought they were a freak or going to hell, or a peer group that delighted in picking on them. Throw in normal pre-teen and teen stressors and mental illnesses that can also be comorbidities. It’s a complex situation  

 

I disagree with the notion that it is impossible to conduct a well designed study in this context. I agree that there are unique challenges and agree with the specific challenges you describe. These challenges are not unique to this particular discussion, though. Similar challenges are present in a variety of therapeutic areas, mental health treatment in particular. In a typical clinical trial context, you would need multiple studies using random assignment and sufficient sample size to condition on these factors. But random assignment would be a challenge in terms of viability of recruitment here I think. That said, certain prospective observation data could be generated using a suitable comparison group or groups (e.g. psychotherapy). To the extent that you can identify potential confounders in advance, you can measure those confounders and adjust for them in the analysis. Yes, it is complex, but clinical research focussed on any variety of psychological and mental health conditions is complex.  

[Willfully Horn 7,908]

Following up on societal stigmatization, a two minute video can inform, and enlighten, and conceivably improve mental health for the most at risk demographic among us. I’m sure the contrarian posters on this board would support this approach, don’t you think? It is fair to say Republican politicians would say that this is “grooming.”

Effect of a Brief Social Contact Video on Transphobia and Depression-Related Stigma Among Adolescents

Findings  In this randomized clinical trial of 1098 adolescents, a significant change in attitudes was found toward transgender youth only in the intervention groups, especially among participants who self-identified as cisgender and/or of heterosexual orientation. As anticipated, a significant reduction in depression-related stigma was also found across all study groups.

 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789426

 

[Anastasis 23,274]

1 hour ago, troph said:

The only issue raised in your post is proper diagnosis not effectiveness of treatment.

I think that you need to read that post again, troph.  Or maybe I am not following what distinction you are trying to make here.  That post is about the evidence base for gnrh and hormone supplementation, and refers to summaries based on systematic evidence reviews. 

1 hour ago, troph said:

so in that backdrop understand you do not sound like a concerned professional, you sound like a person who is uncomfortable with others seeking treatment and are hiding behind your education and professionalism to do what people have done for decades, block treatment.

I am not particularly uncomfortable with people seeking treatment. And to be honest, I don't really personally care if some parent desperate to give relief to their child decides to administer puberty blockers and chase that with exogenous hormones. I can understand that in certain situations where other alternatives have been exhausted, people will cling to anything representing a glimmer of hope. OTOH, I am very uncomfortable with people strongly stating that the clinical research evidence is clear and demonstrates x, y, and z benefits with A and B medications when it does nothing of the sort. That is medical misinformation. I know that I will hear all types of rhetoric about why this case is different than all the others, why the well designed research studies are not tenable, and that anyone who points out the reality of the evidence is a fascist right winger [or whatever] nonsense. I get that. Doesn't change the evidence.  

[Sawbonz 27,087]

1 hour ago, Anastasis said:

I think that you need to read that post again, troph.  Or maybe I am not following what distinction you are trying to make here.  That post is about the evidence base for gnrh and hormone supplementation, and refers to summaries based on systematic evidence reviews. 

I am not particularly uncomfortable with people seeking treatment. And to be honest, I don't really personally care if some parent desperate to give relief to their child decides to administer puberty blockers and chase that with exogenous hormones. I can understand that in certain situations where other alternatives have been exhausted, people will cling to anything representing a glimmer of hope. OTOH, I am very uncomfortable with people strongly stating that the clinical research evidence is clear and demonstrates x, y, and z benefits with A and B medications when it does nothing of the sort. That is medical misinformation. I know that I will hear all types of rhetoric about why this case is different than all the others, why the well designed research studies are not tenable, and that anyone who points out the reality of the evidence is a fascist right winger [or whatever] nonsense. I get that. Doesn't change the evidence.  

Unless I missed something nothing you linked points to evidence that these treatments are ineffective. Granted I did not read the 131 page report and I seriously doubt you did either. A quick perusal shows it points out the available studies are weak. Weak evidence that a treatment works is not the same as evidence it doesn’t work. I’m not saying you are trying to make that argument here but I think some here are reading it that way

 

The experts in this field believe the potential benefits outweigh the risks with these medications as part of multidisciplinary, holistic treatment protocols. I have seen no compelling evidence based argument that it shouldn’t be offered 

[Sawbonz 27,087]

2 hours ago, Anastasis said:

I disagree with the notion that it is impossible to conduct a well designed study in this context. I agree that there are unique challenges and agree with the specific challenges you describe. These challenges are not unique to this particular discussion, though. Similar challenges are present in a variety of therapeutic areas, mental health treatment in particular. In a typical clinical trial context, you would need multiple studies using random assignment and sufficient sample size to condition on these factors. But random assignment would be a challenge in terms of viability of recruitment here I think. That said, certain prospective observation data could be generated using a suitable comparison group or groups (e.g. psychotherapy). To the extent that you can identify potential confounders in advance, you can measure those confounders and adjust for them in the analysis. Yes, it is complex, but clinical research focussed on any variety of psychological and mental health conditions is complex.  

What do you think the total number of pre teens and pre-pubertal children who have gender dysphoria and a stable loving home environment, which would allow them to be a part of such a study is? Given the rate of suicide attempts and completions in this population how are you going to convince any parent to risk being in the placebo arm?

 

can you link randomized prospective studies of hormone blockade for precocious puberty? Pubmed search yielded zero

[Anastasis 23,274]

6 minutes ago, Sawbonz said:

Unless I missed something nothing you linked points to evidence that these treatments are ineffective. Granted I did not read the 131 page report and I seriously doubt you did either. A quick perusal shows it points out the available studies are weak. Weak evidence that a treatment works is not the same as evidence it doesn’t work. I’m not saying you are trying to make that argument here but I think some here are reading it that way

Come on sawbonz, you know how medical research works and how hypotheses are tested and how evidence grades are applied. You turn the way that this stuff works in every other setting on its head by asking for someone to prove the null. 

9 minutes ago, Sawbonz said:

The experts in this field believe the potential benefits outweigh the risks with these medications as part of multidisciplinary, holistic treatment protocols. I have seen no compelling evidence based argument that it shouldn’t be offered 

This is not a uniform posture.  And you also know that expert opinion is literally the lowest grade of evidence.

 

[Sawbonz 27,087]

1 minute ago, Anastasis said:

Come on sawbonz, you know how medical research works and how hypotheses are tested and how evidence grades are applied. You turn the way that this stuff works in every other setting on its head by asking for someone to prove the null. 

This is not a uniform posture.  And you also know that expert opinion is literally the lowest grade of evidence.

 

Link an established society that has guidelines that don’t include puberty blockers and exogenous hormone therapy. You can’t seriously be making the argument that nothing should be done because there is not a well designed study