Oct 29, 2023·edited Oct 31, 2023Liked by Bernard Lane
Yep. It's a problem as old as social science: the "best available" evidence is actually shit by any objective standard.
But social scientists and their ethics-challenged soulmates in trans medical science won't admit that, because it undermines the fundamental validity of their professions. So they grade themselves on a MASSIVE curve.
Not only did they have no control group and screened out all the kids with pre-existing co-morbidities and ran two simultaneous parallel treatments, but they blithely ignored the fact that long-term blocking of normal puberty had never been done on a meaningful scale before, and was experimental and risky to say the least, and designed no safeguards against or even protocols to assess potential negative effects. It was profoundly irresponsible.
Whoever approved and funded the study, whoever approved its publication, all have part of the blame aside from the main culprits whose names are on it.
What struck me was the question that was not put to de Vries—why do you even bother doing research? De Vries rules out a placebo control group as unethical because some patients would be denied treatment that *she just knows* is beneficial.
Virtually every principle enshrined in the practice of medicine to ensure safety and efficacy has been ignored in the in the evolving discipline of ‘gender medicine’
In any normal circumstance such ‘progress’ would demand cessation and accountability yet that is not so.
Somehow a notion as irrational as changing girls into boys and boys into girls has taken hold and seen as a logical next-step in that frontier where the rules don’t hold and the pursuit is noble.
Just to note, even the original Dutch protocol patients, who jumped through all the hoops, so to speak, have not been shown to thrive long term. Where are they beyond the 1 year honeymoon period (they were checked for mental health around 1-2 years after the surgery)?
DeVries says in the video that they want studies, but the kids from the 2011 and 2014 study are now at least 10 years past surgery (they were 1 year in 2014 at least), so this might be a good time to check. And the Dutch have tried, and reported on some of their results at the WPATH 2022 conference, and some of these were then described in Abbruzzese et al (2023), one can hope the Dutch will provide more information. Here is what Abbruzzese et al (2023) repeated from the Dutch:
"Nearly a quarter of the participants have felt that their bodies were still too masculine, and over half have experienced shame for the “operated vagina” and fearful their partner will find out their post-surgical status—despite registering low “gender dysphoria” UGDS scores (Steensma et al., 2022).”
“...the reported relationship difficulties reported by Asseler, with over 60% of individuals in their early to mid-30’s still single, also deserve serious consideration. The apparent sexual difficulties reported by male-to-female transitioners by van der Meulen (around 70% have problems with libido, have pain during sex, or have problems with achieving orgasm), combined with reproductive challenges, may be contributing to this outcome."
"the rate of cross-sex identification was not as stable as originally expected, with a sizable percentage reporting one or more instances of identity changes after treatment completion, especially among the individuals on the autistic spectrum (Steensma et al., 2022)."
The longer more descriptive versions of these outcomes would be welcome....it is time for these outcomes to be known, not just to be told, let's start with a new group and follow them for 10 years. They've been getting medicalized for over 10 years by this clinic even for the 2014 study, so where are they now?
How are all their patients faring?
The other question--who would have been better off without this treatment--they have no idea. Adult studies (e.g. the corrected Bränström and Pachankis) found no advantage for any of the outcomes they measured, for either hormones or surgery.
We already know how they're going to fare. The objective evidence is piling up and all of it points in the same direction.
The long-term followup studies show that actual suicide attempt/success rates increase, mental health doesn't improve, and other health problems crop up.
This retrospective study on 9 years of healthcare data from US military shows that kids showed no decrease in mental health care utilization, and were prescribed psychotropic meds more often after transition than before: https://pubmed.ncbi.nlm.nih.gov/34247956/
This short-term US followup (2 years) illustrates the hazards of relying on self-assessments. The kids SAID they had fewer suicidal thoughts, but their rate of ACTUAL suicides jumped:
Note that all the evidence in these studies is objective, rather than simply being self-assessments by the trans patients. You'll find that every study that claims transitioning improves mental health relies entirely on self-assessments by the patients. Which is low-quality data, scientifically speaking.
I have been taking notes on trans for decades, and identified 7 levels of confabulatory delusion which emerges in response to the argument I call “reductio ad mortem” - without adoption of the delusion you are complicit in death. The level we are observing here is a 5 or 6 - it requires synchronized affirmation and application of pseudoscience to “prevent death”, originally done by single doctors who deny science then clinics, pharmacists and so-called therapists working in synchrony to affirm a confabulatory delusion, then pulling in legal and educational and political systems to adopt the pseudo-science.
There is no logical functional difference between the politician proposing denying reality in legal recognition of a delusion as reality, a clinician who rejects science and reality to confirm a delusion, or the parents who deny reality ( and.parental responsibility) by humoring a delusion, or the child who asserts that clearly observable facts are false.
There’s a simple test, if you are told that an easily observable fact is false (sex is a spectrum) and that any rejection of that assertion will result in a dead child (reductio ad mortem) you’re facing a person or group who needs cult “reprogramming.” - you can’t fight it alone. It’s like trying to argue with an Alcoholic in denial.
The poor Dutch clinician who still is plugging away at the Dutch clinic needs as much help to emerge into the real world as an anorexic or schizophrenic.
“A key figure in the Dutch research, Dr Annelou de Vries, chief psychiatrist at the Amsterdam University Medical Centre, protested in the Zembla program that the use of a control group—to enable comparison of outcomes between treated and untreated patients—would have been unethical.”
This is what zealots always say when they are proposing a new treatment. That it is self evident that the new wonderful treatment is so effective that to do a controlled trial would be unfair to those assigned to control.
But the experience with transgender treatment shows exactly why we would have been in a much better position if a robust trial had been done at the outset.
A double blind placebo controlled randomised trial should be done as soon as possible even now.
We know that there is no good evidence that the affirmative model reduces suicide or improves mental health and it is associated with possible severe side effects including the almost certain progression to mutilating surgery.
Contrary to what the zealots think an ethics committee might knock back the trial not because they think missing out on the active treatment is unfair but the exact opposite: they might well think the active treatment is possibly too dangerous and ineffective to proceed to a trial.
Despite these possible problems if an ethics committee can be persuaded to allow a trial I believe a placebo controlled trial should be possible.
This would need to be conducted by a group independent of active gender physicians who may have too much skin in the game to conduct the trial fairly and dispassionately.
While not wanting to preempt the outcome of an appropriate clinical trial I believe with conviction that the optimal outcome would be those individual in the control group.
The parts where DeVries is interviewed are chilling because I got the sense that she knows that her/colleagues clinical practice and foundations are hugely flawed but is in so deep that there can't be a full admission.
Thanks for this. Have not yet seen documentary. But I think altogether too much attention has been paid to this "Dutch protocol" business. In the first place, adolescents were being treated for TSism many years before the current hoohah about puberty blockers. PBs were introduced in recent years as a cautious substitute for sex hormones. They were not innovative in themselves. They'd been implemented for a virtually identical condition, precocious puberty, for 30 years, so there was nothing experimental about them.
I think the parallel between blockers for precocious puberty & gender dysphoria blockers has been demolished, including by Hilary Cass.
And I think the global explosion in gender clinic patients would not have happened without this innovative (polite word for experimental) use of blockers.
An alternative argument about too much emphasis on the Dutch protocol is that those simply don’t apply today’s typical gender clinic patient: a teenage girl often with mental health problems but no childhood history of gender distress.
The Cass report demonstrated that the patients weren't being treated at all. They were being kicked down the road. Quincy Bell was kicked down the road for 4 or 5 years until finally he/she was put on PBs at age 17. What is the point of getting puberty blockers age 17?
I don’t think the exact number is known but from memory about 1,000?were put on blockers. And in some cases the view of concerned clinicians was that there wasn’t time for proper assessment. This is documented in Hannah Barnes’ book.
The Tavistock did start to give blockers much younger than 17. They knew there was no data for this group, hence their Early Intervention study. And then, before they had full data from the study & with preliminary data suggesting no mental health benefits from blockers, they introduced early blockers as routine treatment. That decision has been heavily criticised.
Yep. It's a problem as old as social science: the "best available" evidence is actually shit by any objective standard.
But social scientists and their ethics-challenged soulmates in trans medical science won't admit that, because it undermines the fundamental validity of their professions. So they grade themselves on a MASSIVE curve.
Not only did they have no control group and screened out all the kids with pre-existing co-morbidities and ran two simultaneous parallel treatments, but they blithely ignored the fact that long-term blocking of normal puberty had never been done on a meaningful scale before, and was experimental and risky to say the least, and designed no safeguards against or even protocols to assess potential negative effects. It was profoundly irresponsible.
Whoever approved and funded the study, whoever approved its publication, all have part of the blame aside from the main culprits whose names are on it.
What struck me was the question that was not put to de Vries—why do you even bother doing research? De Vries rules out a placebo control group as unethical because some patients would be denied treatment that *she just knows* is beneficial.
Virtually every principle enshrined in the practice of medicine to ensure safety and efficacy has been ignored in the in the evolving discipline of ‘gender medicine’
In any normal circumstance such ‘progress’ would demand cessation and accountability yet that is not so.
Somehow a notion as irrational as changing girls into boys and boys into girls has taken hold and seen as a logical next-step in that frontier where the rules don’t hold and the pursuit is noble.
Just to note, even the original Dutch protocol patients, who jumped through all the hoops, so to speak, have not been shown to thrive long term. Where are they beyond the 1 year honeymoon period (they were checked for mental health around 1-2 years after the surgery)?
DeVries says in the video that they want studies, but the kids from the 2011 and 2014 study are now at least 10 years past surgery (they were 1 year in 2014 at least), so this might be a good time to check. And the Dutch have tried, and reported on some of their results at the WPATH 2022 conference, and some of these were then described in Abbruzzese et al (2023), one can hope the Dutch will provide more information. Here is what Abbruzzese et al (2023) repeated from the Dutch:
"Nearly a quarter of the participants have felt that their bodies were still too masculine, and over half have experienced shame for the “operated vagina” and fearful their partner will find out their post-surgical status—despite registering low “gender dysphoria” UGDS scores (Steensma et al., 2022).”
“...the reported relationship difficulties reported by Asseler, with over 60% of individuals in their early to mid-30’s still single, also deserve serious consideration. The apparent sexual difficulties reported by male-to-female transitioners by van der Meulen (around 70% have problems with libido, have pain during sex, or have problems with achieving orgasm), combined with reproductive challenges, may be contributing to this outcome."
"the rate of cross-sex identification was not as stable as originally expected, with a sizable percentage reporting one or more instances of identity changes after treatment completion, especially among the individuals on the autistic spectrum (Steensma et al., 2022)."
The longer more descriptive versions of these outcomes would be welcome....it is time for these outcomes to be known, not just to be told, let's start with a new group and follow them for 10 years. They've been getting medicalized for over 10 years by this clinic even for the 2014 study, so where are they now?
How are all their patients faring?
The other question--who would have been better off without this treatment--they have no idea. Adult studies (e.g. the corrected Bränström and Pachankis) found no advantage for any of the outcomes they measured, for either hormones or surgery.
We already know how they're going to fare. The objective evidence is piling up and all of it points in the same direction.
The long-term followup studies show that actual suicide attempt/success rates increase, mental health doesn't improve, and other health problems crop up.
Sweden long-term post-op: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885
Denmark long-term followup on suicides: https://jamanetwork.com/journals/jama/article-abstract/2806531
--on mental health diagnoses/prescriptions: https://academic.oup.com/ejendo/article-abstract/189/3/336/7261571
--on cardiac issues: https://academic.oup.com/ejendo/article-abstract/187/3/463/6972096
This retrospective study on 9 years of healthcare data from US military shows that kids showed no decrease in mental health care utilization, and were prescribed psychotropic meds more often after transition than before: https://pubmed.ncbi.nlm.nih.gov/34247956/
This short-term US followup (2 years) illustrates the hazards of relying on self-assessments. The kids SAID they had fewer suicidal thoughts, but their rate of ACTUAL suicides jumped:
https://www.nejm.org/doi/full/10.1056/NEJMoa2206297
This study shows that blockers lower IQ: https://www.frontiersin.org/articles/10.3389/fpsyg.2017.00044/
Blockers hinder development: report from SEGM Conference: https://lgbtcouragecoalition.substack.com/p/in-the-room-where-it-happened
Note that all the evidence in these studies is objective, rather than simply being self-assessments by the trans patients. You'll find that every study that claims transitioning improves mental health relies entirely on self-assessments by the patients. Which is low-quality data, scientifically speaking.
I have been taking notes on trans for decades, and identified 7 levels of confabulatory delusion which emerges in response to the argument I call “reductio ad mortem” - without adoption of the delusion you are complicit in death. The level we are observing here is a 5 or 6 - it requires synchronized affirmation and application of pseudoscience to “prevent death”, originally done by single doctors who deny science then clinics, pharmacists and so-called therapists working in synchrony to affirm a confabulatory delusion, then pulling in legal and educational and political systems to adopt the pseudo-science.
There is no logical functional difference between the politician proposing denying reality in legal recognition of a delusion as reality, a clinician who rejects science and reality to confirm a delusion, or the parents who deny reality ( and.parental responsibility) by humoring a delusion, or the child who asserts that clearly observable facts are false.
There’s a simple test, if you are told that an easily observable fact is false (sex is a spectrum) and that any rejection of that assertion will result in a dead child (reductio ad mortem) you’re facing a person or group who needs cult “reprogramming.” - you can’t fight it alone. It’s like trying to argue with an Alcoholic in denial.
The poor Dutch clinician who still is plugging away at the Dutch clinic needs as much help to emerge into the real world as an anorexic or schizophrenic.
“A key figure in the Dutch research, Dr Annelou de Vries, chief psychiatrist at the Amsterdam University Medical Centre, protested in the Zembla program that the use of a control group—to enable comparison of outcomes between treated and untreated patients—would have been unethical.”
This is what zealots always say when they are proposing a new treatment. That it is self evident that the new wonderful treatment is so effective that to do a controlled trial would be unfair to those assigned to control.
But the experience with transgender treatment shows exactly why we would have been in a much better position if a robust trial had been done at the outset.
A double blind placebo controlled randomised trial should be done as soon as possible even now.
We know that there is no good evidence that the affirmative model reduces suicide or improves mental health and it is associated with possible severe side effects including the almost certain progression to mutilating surgery.
Contrary to what the zealots think an ethics committee might knock back the trial not because they think missing out on the active treatment is unfair but the exact opposite: they might well think the active treatment is possibly too dangerous and ineffective to proceed to a trial.
Despite these possible problems if an ethics committee can be persuaded to allow a trial I believe a placebo controlled trial should be possible.
This would need to be conducted by a group independent of active gender physicians who may have too much skin in the game to conduct the trial fairly and dispassionately.
While not wanting to preempt the outcome of an appropriate clinical trial I believe with conviction that the optimal outcome would be those individual in the control group.
Bernard, Benjamin Ryan has a twitter thread on it....interestingly enough, no comments so far:
https://twitter.com/benryanwriter/status/1718408007946555702
The parts where DeVries is interviewed are chilling because I got the sense that she knows that her/colleagues clinical practice and foundations are hugely flawed but is in so deep that there can't be a full admission.
Thanks for this. Have not yet seen documentary. But I think altogether too much attention has been paid to this "Dutch protocol" business. In the first place, adolescents were being treated for TSism many years before the current hoohah about puberty blockers. PBs were introduced in recent years as a cautious substitute for sex hormones. They were not innovative in themselves. They'd been implemented for a virtually identical condition, precocious puberty, for 30 years, so there was nothing experimental about them.
I think the parallel between blockers for precocious puberty & gender dysphoria blockers has been demolished, including by Hilary Cass.
And I think the global explosion in gender clinic patients would not have happened without this innovative (polite word for experimental) use of blockers.
An alternative argument about too much emphasis on the Dutch protocol is that those simply don’t apply today’s typical gender clinic patient: a teenage girl often with mental health problems but no childhood history of gender distress.
I
The Cass report demonstrated that the patients weren't being treated at all. They were being kicked down the road. Quincy Bell was kicked down the road for 4 or 5 years until finally he/she was put on PBs at age 17. What is the point of getting puberty blockers age 17?
Your criticism is always welcome.
It’s true there was (and is) a huge waiting list.
I don’t think the exact number is known but from memory about 1,000?were put on blockers. And in some cases the view of concerned clinicians was that there wasn’t time for proper assessment. This is documented in Hannah Barnes’ book.
The Tavistock did start to give blockers much younger than 17. They knew there was no data for this group, hence their Early Intervention study. And then, before they had full data from the study & with preliminary data suggesting no mental health benefits from blockers, they introduced early blockers as routine treatment. That decision has been heavily criticised.
Version with English narration now available from Zembla: https://www.youtube.com/watch?v=IXPWpDYoPKQ
Is anyone aware of a version of this documentary with English subtitles? I would love to watch it and share with others.