LBGTQ

[Anastasis 23699]

5 minutes ago, Sawbonz said:

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?

There is nothing in that post that suggests you would need a clean environmental context to be included in such a prospective observational study.  In fact the opposite, that such confounders are expected, can be measured, and can be controlled for in the analysis. And there is no where that I suggest a placebo group is required, in fact the opposite was suggested as a specific, psychotherapy applied in an active control context.  

[Anastasis 23699]

32 minutes ago, Sawbonz said:

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

You cited expert opinion. I responded rightfully, that expert opinion is the lowest grade evidence.  Then you ask me to cite expert opinion.

I am making the arguments that I make in my own words. I am not making arguments that I have not made. 

If you ask me what I would do in the situation where my own young adolescent daughter was experiencing gender dysphoria, I think that I would try the engage the same type of first line treatment that you would in a similar situation. Psychotherapy. I certainly would not jump right in with a gnrh analogue.  Is that where you would go with first line treatment? Cause I doubt it. Could be wrong though. 

[Sawbonz 28079]

Pretty good review article of studies in adults. 
 

Gender affirming exogenous hormone therapy is associated with improved QOL
 

 

 

[Sawbonz 28079]

33 minutes ago, Anastasis said:

You cited expert opinion. I responded rightfully, that expert opinion is the lowest grade evidence.  Then you ask me to cite expert opinion.

I am making the arguments that I make in my own words. I am not making arguments that I have not made. 

If you ask me what I would do in the situation where my own young adolescent daughter was experiencing gender dysphoria, I think that I would try the engage the same type of first line treatment that you would in a similar situation. Psychotherapy. I certainly would not jump right in with a gnrh analogue.  Is that where you would go with first line treatment? Cause I doubt it. Could be wrong though. 

Do you seriously think there are parents out there whose first thoughts when their 9yo daughter tells them I think I am a boy is to start gnrh? If you are going to argue the absurd I think we are done. 
 

I, and the serious people on this thread, are talking about children who have gone through an exhaustive diagnostic and therapeutic process that ends up at the point where transitioning is in the best interest of the child. If my child got to that point I would absolutely begin hormone blockers, along with continued psychotherapy, and probably at 16 or 17 begin exogenous hormones. 
 

 

Edited February 6, 2023 by Sawbonz

[Anastasis 23699]

35 minutes ago, Sawbonz said:

Do you seriously think there are parents out there whose first thoughts when their 9yo daughter tells them I think I am a boy is to start gnrh? If you are going to argue the absurd I think we are done. 

I am not the one arguing the absurd here sawbonz. And my hypothetical example was an adolescent. 

 

35 minutes ago, Sawbonz said:

continued psychotherapy

So we agree on first line treatment decisions we would make. 

[Sawbonz 28079]

4 minutes ago, Anastasis said:

am not the one arguing the absurd here

Can you quote the absurd argument?

[Sawbonz 28079]

5 minutes ago, Anastasis said:

And my hypothetical example was an adolescent. 

Ok so 10 yo? You really think that makes a difference?

[Anastasis 23699]

3 minutes ago, Sawbonz said:

Can you quote the absurd argument?

You mean other than the one where you flip evidence based medicine on its head by suggesting that we need to fundamentally abandon the null hypothesis in this particular case because nobody has decisively rejected the null hypothesis with well designed research studies. Ideology over methodology. This is the real absurdity. 

[Sawbonz 28079]

3 minutes ago, Anastasis said:

You mean other than the one where you flip evidence based medicine on its head by suggesting that we need to fundamentally abandon the null hypothesis in this particular case because nobody has decisively rejected the null hypothesis with well designed research studies. Ideology over methodology. This is the real absurdity. 

What I said was the lack of high-quality evidence for the effectiveness of a treatment is not evidence of a lack of effectiveness of a treatment. That is absolutely correct. I’m not sure what you’re on about otherwise other than just wanting to be argumentative. I have acknowledged that there are not high-quality studies. The best evidence in this case is expert opinion. While this is obviously the lowest level evidence, it is absurd to discount it outright, which is what you seem to be wanting to do. 

 

 

 

And the idea of quibbling between nine years old and 10 years old in terms of defining an adolescent is pretty ridiculous.

Edited February 6, 2023 by Sawbonz

[Anastasis 23699]

23 minutes ago, Sawbonz said:

And the idea of quibbling between nine years old and 10 years old in terms of defining an adolescent is pretty ridiculous.

I didn't quibble.  I am surprised that you would consider giving gnrh analogues for gender dysphoria to either a 9 or a 10 year old. The ring of absurdity is just expanding. 

 

23 minutes ago, Sawbonz said:

I have acknowledged that there are not high-quality studies. The best evidence in this case is expert opinion.

I can land on this as a point of agreement.  

Edited February 6, 2023 by Anastasis

[ultimaton 2985]

17 minutes ago, Sawbonz said:

What I said was the lack of high-quality evidence for the effectiveness of a treatment is not evidence of a lack of effectiveness of a treatment. That is absolutely correct. I’m not sure what you’re on about otherwise other than just wanting to be argumentative. I have acknowledged that there are not high-quality studies. The best evidence in this case is expert opinion. While this is obviously the lowest level evidence, it is absurd to discount it outright, which is what you seem to be wanting to do. 

 

 

 

And the idea of quibbling between nine years old and 10 years old in terms of defining an adolescent is pretty ridiculous.

[Sawbonz 28079]

Just now, Anastasis said:

I am surprised that you would consider giving gnrh analogues to either a 9 or a 10 year old.

Now you are outright lying. 

 

1 hour ago, Sawbonz said:

Do you seriously think there are parents out there whose first thoughts when their 9yo daughter tells them I think I am a boy is to start gnrh

 

1 hour ago, Anastasis said:

If you ask me what I would do in the situation where my own young adolescent daughter was experiencing gender dysphoria, I think that I would try the engage the same type of first line treatment that you would in a similar situation. Psychotherapy. I certainly would not jump right in with a gnrh analogue

 

[Anastasis 23699]

There is nothing there that is a lie. You are on tilt. I still find it hard to believe that you would support use of gnrh in a 9 or 10 year old with gender dysphoria. I don’t even think that expert opinion reaches that young. 

Edited February 6, 2023 by Anastasis

[Sawbonz 28079]

2 minutes ago, Anastasis said:

There is nothing there that is a lie. You are on tilt. I still find it hard to believe that you would support use of gnrh in a 9 or 10 year old with gender dysphoria. 

Quote my statement saying I would use gnrh in a 9 or 10 yo with gender dysphoria

Edited February 6, 2023 by Sawbonz

[Anastasis 23699]

6 minutes ago, Sawbonz said:

Quote my statement saying I would use gnrh in a 9 or 10 yo with gender dysphoria

Right after you quote the part of my post that was a lie. 

[Sawbonz 28079]

Just now, Anastasis said:

Right after you quote the part of my post that was a lie. 

 

21 minutes ago, Anastasis said:

I am surprised that you would consider giving gnrh analogues for gender dysphoria to either a 9 or a 10 year old

 

[Anastasis 23699]

Just now, Sawbonz said:

 

 

I guess I missed the beat here. We appear to agree on where we would engage with first line treatment. We appear to agree on the lack of evidence for gnrh and hormone treatments, and that the best grade you get here is expert opinion. We appear to agree on the inappropriateness of gnrh in early adolescents for treatment of gender dysmorphia. But I am the one being argumentative I guess?  

[Sawbonz 28079]

Just now, Anastasis said:

I guess I missed the beat here. We appear to agree on where we would engage with first line treatment. We appear to agree on the lack of evidence for gnrh and hormone treatments, and that the best grade you get here is expert opinion. We appear to agree on the inappropriateness of gnrh in early adolescents for treatment of gender dysmorphia. But I am the one being argumentative I guess?  

That doesn’t look like a quote of me advocating for gnrh therapy in 9 and 10 year olds. Or am I missing something?

[Anastasis 23699]

1 minute ago, Sawbonz said:

That doesn’t look like a quote of me advocating for gnrh therapy in 9 and 10 year olds. Or am I missing something?

Apparently I misinterpreted your response where you invoked a 9 year old after I referenced an adolescent female in the context of medication treatment decisions. 
 

Do we agree on the things I just listed?

[Sawbonz 28079]

1 minute ago, Anastasis said:

Apparently I misinterpreted your response where you invoked a 9 year old after I referenced an adolescent female in the context of medication treatment decisions. 
 

Do we agree on the things I just listed?

Sure. I doubt anyone here would have significant issues with any of what was listed. 

 

My initial point was lack of strong supporting evidence of effectiveness is not strong supporting evidence of lack of effectiveness. And it is very common when high quality evidence is unavailable to defer to expert opinion. It is far from ideal, but doing nothing in the absence of high level studies is not what happens in clinical practice. You may want it to be that way, and you are free to treat you and yours after that fashion. But you would be an outlier. 

[safe sex 11913]

The very second that a pube, vocal crack, breast bud, menarche, or any other pubertal secondary sex characteristic begins to show in a kid who has shown insistent, persistent, and consistent feelings of gender dysphoria or outright desire to transition, that child should begin to receive puberty blockers. DGAF how old they are. Puberty is t o r t u r e to trans children. It is extremely traumatic, and to force a child to undergo that when they are trans is tantamount to abuse. Over half of the trans patients I see at my clinic have obvious signs of self-harm on their bodies. I wonder when they were doing that?

[Anastasis 23699]

11 minutes ago, Sawbonz said:

My initial point was lack of strong supporting evidence of effectiveness is not strong supporting evidence of lack of effectiveness. 

Again, you fundamentally mischaracterize the appropriate null posture that underlies evidence based medicine. 

 

11 minutes ago, Sawbonz said:

And it is very common when high quality evidence is unavailable to defer to expert opinion. It is far from ideal, but doing nothing in the absence of high level studies is not what happens in clinical practice.

You inappropriately equate "there is no good evidence that these particular treatments work and that the risk/benefit assessment supports their use" with "there is nothing that we can do". 

Do you disagree with the posture of the Swedish position statement as articulated in what I linked earlier?

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. 

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.

...

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.

Edited February 6, 2023 by Anastasis

[safe sex 11913]

The research that you want to happen is just never going to happen. I wish it would, but it won't. So let's listen to the lived experiences of trans people, their parents, and the healthcare providers who work with them, maybe?🤷‍♀️

[Sawbonz 28079]

10 minutes ago, Anastasis said:

Again, you fundamentally mischaracterize the appropriate null posture that underlies evidence based medicine. 

 

You inappropriately equate "there is no good evidence that these particular treatments work and that the risk/benefit assessment supports their use" with "there is nothing that we can do". 

Do you disagree with the posture of the Swedish position statement as articulated in what I linked earlier?

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. 

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.

...

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 I do disagree. See safe sex’s post above. And for the reasons I have given above. These medications have been safely and effectively used for decades for precocious puberty and hypogonadism. It is ridiculous to think they would somehow have a different risk profile for use in gender dysphoria. We are getting more decent level studies in adults on exogenous hormone benefits. There is no reason to think this could not be extrapolated to pubertal patients. 
 

eta what “treatment” alternative would you offer a 13yo prepubertal biological male who believes they are a girl?

Edited February 6, 2023 by Sawbonz

[Anastasis 23699]

2 minutes ago, safe sex said:

The research that you want to happen is just never going to happen. I wish it would, but it won't. So let's listen to the lived experiences of trans people, their parents, and the healthcare providers who work with them, maybe?🤷‍♀️

Sounds like you clinic would be a good investigational site. I mean that sincerely. You indicated that there are children walking out your doors in a state because their parents will not consent to hormone treatment. Everyone is telling me that we cannot do control groups but there you go. Recruit them to a psychotherapy treatment control arm. Assuming that the parents you describe are treatment seeking by virtue of the fact that they are the ones taking their children to a specialty clinic, but they are not ready to make the jump to pharmacotherapy, can we connect that they would be at least be open to being offered non-pharmacological treatment options? Or are these parents open to taking their kids to speciality clinics not open to any clinical intervention?

[Anastasis 23699]

8 minutes ago, Sawbonz said:

These medications have been safely and effectively used for decades for precocious puberty and hypogonadism. It is ridiculous to think they would somehow have a different risk profile for use in gender dysphoria.

The risk/benefit dynamic is different for different indications, but you know this. 

[Sawbonz 28079]

Just now, Anastasis said:

The risk/benefit dynamic is different for different indications, but you know this. 

The risk profile is independent of the risk/ benefit dynamic. But you know this.
 

And in this case the benefit is unknown due to poorly designed and underpowered studies. But you know this as well

[safe sex 11913]

8 minutes ago, Anastasis said:

Sounds like you clinic would be a good investigational site. I mean that sincerely. You indicated that there are children walking out your doors in a state because their parents will not consent to hormone treatment. Everyone is telling me that we cannot do control groups but there you go. Recruit them to a psychotherapy treatment control arm. Assuming that the parents you describe are treatment seeking by virtue of the fact that they are the ones taking their children to a specialty clinic, but they are not ready to make the jump to pharmacotherapy, can we connect that they would be at least be open to being offered non-pharmacological treatment options? Or are these parents open to taking their kids to speciality clinics not open to any clinical intervention?

Even in Austin, resources are very limited for trans people, whether it be hormonal therapy access or psychotherapy. More than half of our patients are uninsured, which further complicates things. My company pays for a large percentage of the medications given to our patients, and we depend on the largesse of the state of Texas and drug companies for the rest.

I would love to use my clinic for a research site, but...bitch, who is going to pay for that? Where are these resources going to come from?  We're more worried about keeping the lights on, a stable staff, and staying within the legal bounds set for us by the theocratic government of Texas.

5 minutes ago, Anastasis said:

The risk/benefit dynamic is different for different indications, but you know this. 

Again, the outcome of death  is a huge risk factor for trans people (in any stage of life). Ask almost any trans person and they will tell you that they wish they'd been able to start earlier, before puberty warped their bodies irrevocably. HRT post-puberty is damage control.

Edited February 6, 2023 by safe sex

[Anastasis 23699]

Just now, Sawbonz said:

The risk profile is independent of the risk/ benefit dynamic. But you know this.
 

And in this case the benefit is unknown due to poorly designed and underpowered studies. But you know this as well

Yes to both. Only one of us seems to have forgotten that there is a risk/benefit dynamic that must be considered. Again we are upside down here with the fundamental of evidence based medicine.  Known risk, unknown benefit is not a blanket green light.  

[Anastasis 23699]

1 minute ago, safe sex said:

I would love to use my clinic for a research site, but...bitch, who is going to pay for that?

The research reported in the NEJM article cited was supported by an R01 from Eunice Kennedy Shriver National Institute of Child Health and Human Development. 

[Patricio Swayze 17058]

I bet Dan Patrick and friends would LOVE to have the state fund some research.

[Anastasis 23699]

Just now, Patricio Swayze said:

I bet Dan Patrick and friends would LOVE to have the state fund some research.

And no doubt the HHS assistant health secretary if you are chasing that sweet NIH money. 

Funding bias will always exist. Potential financial conflicts of interest will always exist. That is why we have to focus on methodology over ideology. 

[Sawbonz 28079]

8 minutes ago, Anastasis said:

Yes to both. Only one of us seems to have forgotten that there is a risk/benefit dynamic that must be considered. Again we are upside down here with the fundamental of evidence based medicine.  Known risk, unknown benefit is not a blanket green light.  

You seem to want to deal only in absolutes. Good luck with that

[safe sex 11913]

I'm curious, Ana, what level of evidence would suffice for you to say, "Okay, trans kids don't have to go through puberty until they're ready?"

[tigol 2465]

8 minutes ago, Anastasis said:

And no doubt the HHS assistant health secretary if you are chasing that sweet NIH money. 

Funding bias will always exist. Potential financial conflicts of interest will always exist. That is why we have to focus on methodology over ideology. 

We are well beyond "funding bias" in Texas.  But, you know that.

[Anastasis 23699]

19 minutes ago, Sawbonz said:

You seem to want to deal only in absolutes. Good luck with that

I am pretty sure that this is a paraphrase of a triplehorn post back when we were discussing HCQ.

17 minutes ago, safe sex said:

I'm curious, Ana, what level of evidence would suffice for you to say, "Okay, trans kids don't have to go through puberty until they're ready?"

At least a few well executed observational studies with suitable control groups and a well designed statistical analysis plan that accounted for obvious confounders.  I'd prefer some blinding adn random assignment though.   

Edited February 6, 2023 by Anastasis

[Willfully Horn 8204]

@Anastasis, I get that narcissists demean others due to their own insecurities. So, I hope you get help with that. I take offense at being indirectly characterized as spreading medical misinformation. I have offered numerous studies that support the contention that GA medical care lead to improved mental health outcomes, and I will link to yet another, more extensive study that reaches the same conclusion. A study that seemingly, to me, though I will yet again admit I am not adept at medical analysis, meets the complex controls you require. (Eschew informing in favor of contempt, if you so wish). Feel free to dig into this study, though you seemed disinterested in doing so with the last bevy of studies I linked that were easily obtained through a quick search.

I will again point out that the authors of the studies have the same qualifications you esteem above the ability to comprehend a summary, but I get where you are coming from. It must be difficult for a layman to challenge your expertise. Expecting others to value your conclusions over other conclusions, from equally qualified sources, is a function of your narcissism. I get that.

As you have admitted, long term mental health descriptions are complex. You ignored the link that described societal pressure affecting outcomes that were initially 100% positive. You also ignored my contention that fascistic suppression is ongoing in ways that could improve the future of our neighbors who face these difficult circumstances. Under the premise that you are Catholic, I will remind you that the Pope proclaimed Catholics must, must, do all they can to defeat such political oppression.

So, it falls upon you to refute each study that concludes that GA medical care improves the lives of transgendered human beings. You chose that role. I acknowledge you linked a study that agrees with doubts you have, but I have yet to discover a peer reviewed study that shows GA care does not do what the consensus believes.

Without further ado:

https://www.jahonline.org/article/S1054-139X(21)00568-1/fulltext

[safe sex 11913]

47 minutes ago, Anastasis said:

I am pretty sure that this is a paraphrase of a triplehorn post back when we were discussing HCQ.

At least a few well executed observational studies with suitable control groups and a well designed statistical analysis plan that accounted for obvious confounders.  I'd prefer some blinding adn random assignment though.   

But until then, the increased risk of suicide is worth it versus any potential complications in the future? Just want to be clear that this is where you are.

[Anastasis 23699]

7 minutes ago, Willfully Horn said:

I take offense at being indirectly characterized as spreading medical misinformation.

Not everything is about you Willfully.  But please tell us all more about narcissists. 

[Anastasis 23699]

9 minutes ago, Willfully Horn said:

A study that seemingly, to me, though I will yet again admit I am not adept at medical analysis, meets the complex controls you require. 

...

Without further ado:

https://www.jahonline.org/article/S1054-139X(21)00568-1/fulltext

I only had to read the abstract to realize that you are citing a survey study you absolute dolt. 

[Anastasis 23699]

7 minutes ago, safe sex said:

But until then, the increased risk of suicide is worth it versus any potential complications in the future? Just want to be clear that this is where you are.

You beg the question that there is high grade evidence that the hormone treatments reduce suicide risk among early adolescent individuals with gender dysphoria. 

[safe sex 11913]

Can you just answer a fucking question straight for once in your life? jfc

 

[Anastasis 23699]

I think that was fairly direct. 

[Sawbonz 28079]

21 minutes ago, Anastasis said:

You beg the question that there is high grade evidence that the hormone treatments reduce suicide risk among early adolescent individuals with gender dysphoria. 

No she doesn’t. You are the only one here who has set the bar at high grade evidence. And that’s fine for you and yours. It’s not reality in many aspects of clinical practice. And you know that. Good luck with your kids. I hope they only ever have a problems where high quality evidence is available for treatment

Edited February 6, 2023 by Sawbonz

[Anastasis 23699]

Just now, Sawbonz said:

No she doesn’t

yes she does. 

[Sawbonz 28079]

1 minute ago, Anastasis said:

yes she does. 

No she doesn’t 

[Anastasis 23699]

Just now, Sawbonz said:

No she doesn’t 

yes she does. 

 

We can do this recursively, which might be a good encapsulation of this exchange at this point given the lack of evidence to cut through the fog of nonsense. 

[Sawbonz 28079]

1 minute ago, Anastasis said:

yes she does. 

 

We can do this recursively, which might be a good encapsulation of this exchange at this point given the lack of evidence to cut through the fog of nonsense. 

See above. She never mentions need for high quality evidence. That’s all you. Good luck with that.

[Anastasis 23699]

8 minutes ago, Sawbonz said:

You are the only one here who has set the bar at high grade evidence.

In this exchange that might be the case. Which is telling. 

[Sawbonz 28079]

Just now, Anastasis said:

In this exchange that might be the case. Which is telling. 

Oh this exchange is quite telling.