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Cass Report

I'm with those that are very concerned about the how of a human trial; it's easy to say glibly "oh we need to conduct human trials" and put an exception into the guidelines to cover that but what would such a trial entail? Can one ethically be carried out? I have serious doubts that it is possible.
 
Darat said:
I'm with those that are very concerned about the how of a human trial; it's easy to say glibly "oh we need to conduct human trials" and put an exception into the guidelines to cover that but what would such a trial entail? Can one ethically be carried out? I have serious doubts that it is possible.
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One view is in the absence of evidence about what is the best treatement the only ethical option is a trial. There are a variety of methodologies that can take into account patient preference. One suggested model is immediate versus deferred puberty blockers. The deferred group would be offered non-pharmacological intervention to address gender dysphoria and other issues e.g. depression, autism. One outcome might be how many offered intensive non-pharmacological support still opted for pharmacological therapy after e.g. three years.
 
Planigale said:
One view is in the absence of evidence about what is the best treatement the only ethical option is a trial. There are a variety of methodologies that can take into account patient preference. One suggested model is immediate versus deferred puberty blockers. The deferred group would be offered non-pharmacological intervention to address gender dysphoria and other issues e.g. depression, autism. One outcome might be how many offered intensive non-pharmacological support still opted for pharmacological therapy after e.g. three years.
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Blocking puberty in an otherwise-healthy child for three years is almost certainly irreversible and harmful. Assessing the degree of harm isn't really an ethical option.
 
Darat said:
I'm with those that are very concerned about the how of a human trial; it's easy to say glibly "oh we need to conduct human trials" and put an exception into the guidelines to cover that but what would such a trial entail? Can one ethically be carried out? I have serious doubts that it is possible.
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I agree. Before human trials are authorised a whole lot of preliminary data needs to be collected to ensure that there is a reasonable hope that the drug might be of clinical benefit, and that the thing appears to be acceptably safe. I very much doubt that these conditions can be met for a drug intended to block normal puberty.

The safety is doubful, both as regards physical safety (bone density and things like that) and mental safety (the loss of IQ points and the findings with regard to learning and anxiety in sheep). However, sometimes one has to weigh up the balance between risk and benefit. Maybe the benefits of the drug are such that the side-effects are considered to be acceptable?

What are the hoped-for benefits of puberty blockers when given to physically healthy children? Purely psychological. Risk a significant drop in IQ, problems with osteoporosis and probably infertility and lifelong anorgasmia, for what? The standard spiel has been to avoid the risk of suicide. There is precisely the square root of bugger-all evidence that suicide rates are lower in children who have had their puberty blocked.

Beyond that, it's cosmetic. Little Johnny will make a much prettier and more convincing girl if we stop such horrors as a baritone voice and a beard being visited on him.

I mean, what the actual :rule10?
 
Matthew Best said:
Woking isn't a city. It's been in the news twice this week - once because it's the home of McLaren, who won the Formula 1 constructors' championship, and the next time because it was the home of murdered girl Sara Sharif
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Don't make me tell you the Woking joke I know, and risk getting jumped on for off-topic.
 
OK, I can't resist. I Wagner's opera Die Walküre, the hero is going by a pseudonym when he enters. This pseudonym is "Wehwalt", which in German means something like lord of unhappiness or ruler of misery. In an early English translation this pseudonym was rendered as "Woe-King".* In act 2, when the villain is pursuing his former house-guest and calling him by the name he had given, he shouts "Woe-King! Woe-King!"

Of course, some wag in the audience interjected audibly "Next stop Basingstoke!"

*These days it's more likely to be "Woeful", and special bonus points to anyone who can spot the link between that and Neil Gaiman's "American Gods".
 
Reminds of the sad fact that many cities do not have an Vietnamese restaurant called, Pho King.
 
Rolfe said:
I don't think they should even be contemplating a clinical trial on human subjects before completing comprehensive animal testing that demonstrates safety. This simply would not happen in any other area of medicine.

The single animal study I am aware of demonstrated cognitive changes in young sheep which would be considered devastating to an adolescent human being. And that's before we even consider the physical effects on things like bone density.

The trans-activist response to this study was to mock the idea that sheep could be considered in any way comparable to human beings and to dismiss the expertise of the senior scientist involved because he is a veterinary surgeon.

Perhaps worse still, the evidence of bone density effects (in human patients) was concealed by the researchers involved by presenting the results as showing no change in bone density while the children were on treatment. Concealing the fact that at the time they were treated normal adolescents' bone density increases markedly. The puberty blockers had prevented this normal development.

In a sane world where proper animal trials were carried out and a proper retrospective analysis was undertaken of the results recorded in patients who already received the treatment, I don't believe this would ever get as far as a human trial.
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Slight aside... We've known for hundreds of years that neutering animals results in a retention of juvenile behaviors. Geldings are more docile than stallions, largely because they retain the behavioral profile of a foal. They attain generally adult size and proportions, but they don't develop adult behaviors. The same is true for domestic dogs and cats. Sterilized dogs retain a lot of puppy-like behaviors, sterilized cats retain kitten-like behaviors. Steers don't act like bulls. There's an entire set of cognitive behaviors that develop during sexual maturation in mammals. Why we would imagine that humans would be different is a mystery to me.

Also... in male cats, neutering reduces the development of adult male facial conformation. Toms actually look different from neutered males. Body shape, particularly abdominal, is different for spayed females and intact queens.
 
Elaedith said:
In regards to both cognitive and bone density effects, the key question with treating those who cease puberty blockers and go through natal puberty is whether they catch up with peers.
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Based on what little I know of Kallman Syndrome, bone density can only catch up if pubertal hormones are in place prior to the closure of growth plates. My goddaughter has Kallman, and their endocrinologist is one of a very few who specialize in that condition. The endocrinologist was adamant that they needed to start hormone therapy by age 14 at the absolute latest, because delaying beyond that risked permanent low density.

Whether or not cross-sex hormones would address that is something I don't know.
 
Emily's Cat said:
Slight aside... We've known for hundreds of years that neutering animals results in a retention of juvenile behaviors. Geldings are more docile than stallions, largely because they retain the behavioral profile of a foal. They attain generally adult size and proportions, but they don't develop adult behaviors. The same is true for domestic dogs and cats. Sterilized dogs retain a lot of puppy-like behaviors, sterilized cats retain kitten-like behaviors. Steers don't act like bulls. There's an entire set of cognitive behaviors that develop during sexual maturation in mammals. Why we would imagine that humans would be different is a mystery to me.

Also... in male cats, neutering reduces the development of adult male facial conformation. Toms actually look different from neutered males. Body shape, particularly abdominal, is different for spayed females and intact queens.
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Only if neutering is done before puberty. It's quite a debate in veterinary circles.
 
Planigale said:
People who didn't like the conclusions of the Cass report nitpick over methodology but provide no new facts or analysis.
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People who support the Cass review like to forget that she threw out all the scientifically conducted research and accepted the two studies that were by far the most flawed in methodology (so much so that they were Wakefield levels of bad). She later admitted to the Umbrella charity that she had no legitimate reason for doing so and that her conclusions had no scientific basis.

But hey, keep shouting that the Cass review wasn't written to a pre-ordained conclusion. You might even convince yourself some day.
 
Rolfe said:
Only if neutering is done before puberty. It's quite a debate in veterinary circles.
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I think it is worth remembering that what is proposed is not the same as castration as the puberty blockers are a temporising measure, with a view to move to 'pharmacological puberty' either with male hormones for FTM or female hormones for MTF. The alternative is going through natural puberty which may then mean transitioning is more challenging.

The questions one might ask are whether non-pharmacological approaches can address gender dysphoria, or whether it merely delays transitioning. Whether delaying / preventing natural cis-puberty to allow a trans-sex puberty, is better than allowing a cis puberty then trying to reverse it.

My personal view (having been one) is that many teen girls with gender dysphoria will grow out of it and need non-pharmacological support.
 
Gulliver Foyle said:
People who support the Cass review like to forget that she threw out all the scientifically conducted research and accepted the two studies that were by far the most flawed in methodology (so much so that they were Wakefield levels of bad).
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No she didn't. Cass did not make any decisions about what studies in include in the final synthesis; that was done by researchers from the Centre for Reviews and Dissemination at the University of York (a world-leading centre for systematic evidence reviews).
The UoY researchers accepted 60 out of the 103 studies evaluated, not two. The claim that only two were accepted is activist misinformation based on the fact that only two were rated high quality (moderate quality studies were also accepted).

Gulliver Foyle said:
She later admitted to the Umbrella charity that she had no legitimate reason for doing so and that her conclusions had no scientific basis
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No she didn't. That is utter nonsense.
Gulliver Foyle said:
But hey, keep shouting that the Cass review wasn't written to a pre-ordained conclusion. You might even convince yourself some day.
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You are repeating activist lies that can be demonstrated as objectively false with minimal effort, and already have been shown to be false. Why do you think it's ok to lie about a medical review of invasive procedures performed on children?
 
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