In the context of this post it is interesting to reference a recent article in the ‘Clinical Advisory Network on Sex and Gender’, a publication by a group of UK and Irish based clinicians calling for greater understanding of the effects of sex and gender in healthcare.
The summary of that article (that will no doubt be seen as heresy by the affirmative advocates) is quoted herewith:
The evidence that puberty blockers have any kind of beneficial effect on mental health is equivocal. Positive results are frequently held up as evidence that young people must have access to puberty blockers, whilst more troubling results are dismissed as insignificant. Without prospective, controlled studies working to pre-specified protocols that follow up over a longer period of time, it is hard to see how more reliable evidence of safety and effectiveness, with more precision around the sizes of risks and harms, especially for any subgroups, can be gathered.
Given the current acceptance of 'gender affirmation' as best practice in the treatment of gender dysphoric children and young people, how likely is it that any ethics committee will approve a randomised trial of puberty blocker/cross sex hormone intervention protocols? If it means some randomly selected candidates will receive the interventions and others - the control group - will not, how many institutions will be willing to withstand the inevitable backlash from trans rights groups? And who will be willing to fund research when accusations of 'denying lifesaving care' will be made?
There's disagreement about this. On one view, if a jurisdiction bans routine access to blockers, then it is more likely to get co-operation from teens & parents for randomised controlled trials, which can take various forms. Access to online blockers could sabotage this.
The Swedes say: "controlled trials do not necessarily require placebo treatment, but could for example build on the date or time of starting hormonal therapy to generate comparison groups."
Ken Zucker, the gender dysphoria guru, has suggested using the long wait lists for gender clinics as a control group. This would mean baseline measures are collected when the teens join the queue, not when they eventually get their first appointment.
Some have suggested that US states with bans would be good control groups. One could measure the comorbidities for appropriate matching, maybe?
The "lifesaving care" argument is looking pretty sad right now with children who are being treated actually dying, as in Chen et al. (2023), which also won't even release most of the outcomes it said was going to measure and report.
The arguments against rct's always seem to assume that the interventions were beneficial and thus should not be withheld, but that hasn't been shown, finding out is the point of the study-- it's just plain circular :(.
Interesting suggestions, but robust studies would still need matched control groups. They would also need to be controlled to eliminate confounding variables, like co-morbid mental heath conditions such as autism.
Beyond my expertise. But as things stand gender clinic research cites the difficulties of RCTs & refuses to test competing non-invasive treatments against their medical interventions on the basis that any alternative is “doing nothing” & therefore unethical.
Exactly. Gender affirming interventions have become so entrenched that valid research will be impossible. As I have mentioned before, I believe it will take a number of successful medical negligence lawsuits against gender affirming practitioners to bring about change.
There is an analysis of AUSPATH guidelines also by Clayton: https://www.tandfonline.com/doi/full/10.1080/0092623X.2022.2070565 "Commentary on Levine et al.: A Tale of Two Informed Consent Processes" which supports what you are saying even more.
Thank you for this great summary!
Useful link, thanks. B
In the context of this post it is interesting to reference a recent article in the ‘Clinical Advisory Network on Sex and Gender’, a publication by a group of UK and Irish based clinicians calling for greater understanding of the effects of sex and gender in healthcare.
The summary of that article (that will no doubt be seen as heresy by the affirmative advocates) is quoted herewith:
The evidence that puberty blockers have any kind of beneficial effect on mental health is equivocal. Positive results are frequently held up as evidence that young people must have access to puberty blockers, whilst more troubling results are dismissed as insignificant. Without prospective, controlled studies working to pre-specified protocols that follow up over a longer period of time, it is hard to see how more reliable evidence of safety and effectiveness, with more precision around the sizes of risks and harms, especially for any subgroups, can be gathered.
Given the current acceptance of 'gender affirmation' as best practice in the treatment of gender dysphoric children and young people, how likely is it that any ethics committee will approve a randomised trial of puberty blocker/cross sex hormone intervention protocols? If it means some randomly selected candidates will receive the interventions and others - the control group - will not, how many institutions will be willing to withstand the inevitable backlash from trans rights groups? And who will be willing to fund research when accusations of 'denying lifesaving care' will be made?
Fair point, Bronwyn.
There's disagreement about this. On one view, if a jurisdiction bans routine access to blockers, then it is more likely to get co-operation from teens & parents for randomised controlled trials, which can take various forms. Access to online blockers could sabotage this.
The Swedes say: "controlled trials do not necessarily require placebo treatment, but could for example build on the date or time of starting hormonal therapy to generate comparison groups."
https://onlinelibrary.wiley.com/doi/10.1111/apa.16791
Ken Zucker, the gender dysphoria guru, has suggested using the long wait lists for gender clinics as a control group. This would mean baseline measures are collected when the teens join the queue, not when they eventually get their first appointment.
Some have suggested that US states with bans would be good control groups. One could measure the comorbidities for appropriate matching, maybe?
The "lifesaving care" argument is looking pretty sad right now with children who are being treated actually dying, as in Chen et al. (2023), which also won't even release most of the outcomes it said was going to measure and report.
The arguments against rct's always seem to assume that the interventions were beneficial and thus should not be withheld, but that hasn't been shown, finding out is the point of the study-- it's just plain circular :(.
Yes, if gender clinics already know their treatment saves lives, what’s the point of researching it?
Interesting suggestions, but robust studies would still need matched control groups. They would also need to be controlled to eliminate confounding variables, like co-morbid mental heath conditions such as autism.
Beyond my expertise. But as things stand gender clinic research cites the difficulties of RCTs & refuses to test competing non-invasive treatments against their medical interventions on the basis that any alternative is “doing nothing” & therefore unethical.
Exactly. Gender affirming interventions have become so entrenched that valid research will be impossible. As I have mentioned before, I believe it will take a number of successful medical negligence lawsuits against gender affirming practitioners to bring about change.
Bernard, what chance a systematic review here? I think there is probably some hope with NSW. The Victorians are gone.