Tavistock clinic made early puberty blocking standard clinical treatment mid-way through a study of this intervention, then buried the disappointing results for years.
Hormonal treatments at RCH began to take off with sharply rising patient numbers around 2014. They started recruiting for long-term study in 2017 & published the research protocol two years later with the statement that more evidence for these treatments was “urgently needed”. In 2023 even preliminary data on outcomes is yet to be published.
The UK seems to have had the best political leadership so far — the bureaucracy can’t have encouraged ministers to set up & take seriously the Cass review — and yet even in the UK the politicians are erratic, as seen by the embrace of a gender identity conversion therapy ban, as if it has nothing to do with the Cass review.
"Further aspects are perplexing. The statement “a systematic review regarding outcomes of treatment in adolescents is not possible”(pS46) seems strange, given well-known evidence reviews exist[14,15] but are omitted from SoCv8’s references. Statement 2.1 asserts “strong evidence demonstrating the benefits in quality of life and well-being of gender-affirming treatments” (pS18), yet is supported by 21 references without any explanations of the papers’ context or evidentiary validity. This is unconvincing to those external audiences used to judging clinical effectiveness by quality, not quantity.
SoCv8 is “based on the published literature (direct as well as background evidence) [and] on consensus-based expert opinion”(pS247) including a Delphi process, but evidence curation moved on long ago; WPATHs methods are prone to bias and are not “evidence-based”[16-20]. "
I predict the gender affirming practice of minors will be stopped in nearly every country by the end of 2024. The evidence and public push-back is simply too strong. I only wish the ABC, SBS and commercial TV would take notice of the newsworthy surge in de-transitioners rather then gush over WorldPride 2023. It's a very one-sided coverage based on ideology rather then truth-telling.
Hard to call. The "no debate" mob are certainly furious with the NY Times which after years of politicised suppression of the story has lately published a few articles platforming legitimate concerns.
A shift away from the apparent obligatory / default 2018 AAP and Endocrine Society’s “ gender- affirmation “ treatment model , which may occur in a due 2023 review represents a huge clinical/cultural repudiation of the ideological basis of “ gender identity “ , which metastasised from Gender Studies, within the Humanities and Social Sciences a couple of decades ago , throughout the West. If, indeed we are seeing the beginnings of retrieval of evidenced based care, and protection for future vulnerable children ( and protection for clinicians, from punitive legislation, for being deemed of providing “ conversion therapy”) such retrieval will require many political champions , across so many legal jurisdictions. A work in progress. Until there is the ideological confrontation the “ beast gets stronger”and it remains an inexplicable stain on my profession. The ideological activists have been better organised, willing to fight harder, and the “ woke” do not take prisoners. Will we see enough champions in our political leaders?
The 2017 Endocrine Society guideline, often invoked to support gender-affirming hormonal treatment, rated the evidence for almost all its recommendations as “low” or “very low” quality.
In 2019, the Melbourne hospital defended its treatment guidelines as “peer reviewed at the highest level [and] adopted by healthcare providers across Australia and the globe.”
It is difficult to comprehend that given the doubts, recommendations for caution and the ever-increasing concerns raised by authoritative bodies, that these mutilating and irreversible violations of young people are allowed to continue.
Once you've declared a treatment to be "lifesaving", how do you walk it back? Admit you had no basis for that claim? That the sceptics you smeared as bigots were right to be concerned?
Once a treatment is labelled as standard treatment rather than experimental it escapes scrutiny of an ethics committee. It seems to me that this treatment has been experimental
from the start and should now definitely be labelled as such.
This would put the onus on the ethics committee of the RCH to approve it and unless it was a properly constructed trial, with proper end points, statistics , follow up and controls any approval would be subject to severe criticism.
However I expect the RCH Gender Clinic would never accept that and will continue to put vulnerable children on a nearly 100% irreversible pathway to mutilating surgery which is completely irreversible.
This despite a complete lack of robust evidence of its effectiveness.
Tavistock clinic made early puberty blocking standard clinical treatment mid-way through a study of this intervention, then buried the disappointing results for years.
Hormonal treatments at RCH began to take off with sharply rising patient numbers around 2014. They started recruiting for long-term study in 2017 & published the research protocol two years later with the statement that more evidence for these treatments was “urgently needed”. In 2023 even preliminary data on outcomes is yet to be published.
The UK seems to have had the best political leadership so far — the bureaucracy can’t have encouraged ministers to set up & take seriously the Cass review — and yet even in the UK the politicians are erratic, as seen by the embrace of a gender identity conversion therapy ban, as if it has nothing to do with the Cass review.
Thank you!
The 2022 Wpath guidelines were reviewed as a rapid response to the 2021 guideline review you quote:
https://bmjopen.bmj.com/content/11/4/e048943.responses#wpath-standards-of-care-a-new-edition-using-outdated-methods-weakens-the-trustworthiness-of-content
"Further aspects are perplexing. The statement “a systematic review regarding outcomes of treatment in adolescents is not possible”(pS46) seems strange, given well-known evidence reviews exist[14,15] but are omitted from SoCv8’s references. Statement 2.1 asserts “strong evidence demonstrating the benefits in quality of life and well-being of gender-affirming treatments” (pS18), yet is supported by 21 references without any explanations of the papers’ context or evidentiary validity. This is unconvincing to those external audiences used to judging clinical effectiveness by quality, not quantity.
SoCv8 is “based on the published literature (direct as well as background evidence) [and] on consensus-based expert opinion”(pS247) including a Delphi process, but evidence curation moved on long ago; WPATHs methods are prone to bias and are not “evidence-based”[16-20]. "
Thanks! I will add that link. B
I predict the gender affirming practice of minors will be stopped in nearly every country by the end of 2024. The evidence and public push-back is simply too strong. I only wish the ABC, SBS and commercial TV would take notice of the newsworthy surge in de-transitioners rather then gush over WorldPride 2023. It's a very one-sided coverage based on ideology rather then truth-telling.
Hard to call. The "no debate" mob are certainly furious with the NY Times which after years of politicised suppression of the story has lately published a few articles platforming legitimate concerns.
Oh my God, I hope you are right.
A shift away from the apparent obligatory / default 2018 AAP and Endocrine Society’s “ gender- affirmation “ treatment model , which may occur in a due 2023 review represents a huge clinical/cultural repudiation of the ideological basis of “ gender identity “ , which metastasised from Gender Studies, within the Humanities and Social Sciences a couple of decades ago , throughout the West. If, indeed we are seeing the beginnings of retrieval of evidenced based care, and protection for future vulnerable children ( and protection for clinicians, from punitive legislation, for being deemed of providing “ conversion therapy”) such retrieval will require many political champions , across so many legal jurisdictions. A work in progress. Until there is the ideological confrontation the “ beast gets stronger”and it remains an inexplicable stain on my profession. The ideological activists have been better organised, willing to fight harder, and the “ woke” do not take prisoners. Will we see enough champions in our political leaders?
The 2017 Endocrine Society guideline, often invoked to support gender-affirming hormonal treatment, rated the evidence for almost all its recommendations as “low” or “very low” quality.
In 2019, the Melbourne hospital defended its treatment guidelines as “peer reviewed at the highest level [and] adopted by healthcare providers across Australia and the globe.”
It is difficult to comprehend that given the doubts, recommendations for caution and the ever-increasing concerns raised by authoritative bodies, that these mutilating and irreversible violations of young people are allowed to continue.
Once you've declared a treatment to be "lifesaving", how do you walk it back? Admit you had no basis for that claim? That the sceptics you smeared as bigots were right to be concerned?
You nailed it Bernard!
Once a treatment is labelled as standard treatment rather than experimental it escapes scrutiny of an ethics committee. It seems to me that this treatment has been experimental
from the start and should now definitely be labelled as such.
This would put the onus on the ethics committee of the RCH to approve it and unless it was a properly constructed trial, with proper end points, statistics , follow up and controls any approval would be subject to severe criticism.
However I expect the RCH Gender Clinic would never accept that and will continue to put vulnerable children on a nearly 100% irreversible pathway to mutilating surgery which is completely irreversible.
This despite a complete lack of robust evidence of its effectiveness.