Thank you. I had only heard of the Florida review as the only systematic review having taken place in the US. That article by Block is very good, thank you.
Thank you, as always, to both of you for putting these in briefs together. Chakrabarti’s interview with Cass on WBUR was an extraordinary breath of fresh air, wasn’t it? Chakrabarti, as Cass noted at one point, was extremely well prepared. She asked intelligent questions to which Cass gave thoughtful, informative answers. This is the journalism we have needed, and I hope we will see more, including LISA in the New York Times, for heaven’s sake!
I know how hard it is to put these in briefs together, but to the extent possible, I do recommend having antennae up for poor and biased reporting. For example, a piece like this, which gives Chase Strangio at the ACLU such fulsome coverage needs to be a red flag.
I was told by someone who read the on point interview that the two US clinicians sounded like "the UK had problems but we are careful"--I am now trying to emphasize that the "careful" US clinicians are not doing what the UK is doing.
The UK is doing no puberty blockers outside of carefully regulated studies (and there isn't one right now), so I think that is IRB human subject protection study level (the US studies don't always meet this I hear).
Cass recommended giving hormones only with "extreme caution." And a clinician can't make the call on their own. "There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18. Every case considered for medical treatment should be discussed at a national Multi- Disciplinary Team (MDT)."
The US caution looks like doing assessments but as Chakrabarti pointed out:
" That is so remarkable. We don't even know yet what the best assessments are, let alone we don't have an evidence base to know what the best treatments are."
Dr. Tishelman's suggestion that there is research (she is part of Chen et al 2023 which didn't release 6 of the 8 outcomes they said they'd release, where FTM only had small benefit and MTF had no benefit and 2 of the 315 died of suicide)--until there is research they could just stop prescribing for now. Saying they don't know and have to be careful--that might be fine when there are only a few patients a year but now the country is starting 1000's a year on these drugs. The argument that it is too late to be careful...no one should be buying that.
They are providing these interventions without the patients having protections research subjects have. This isn't a case of "we have to do something" as these are physically healthy young people in distress--doing drastic lifelong changes on their physical bodies which are harmful (anyone coming in with those hormone levels who wasn't treating GD would have them treated medically for health reasons!) is happening because the hope is that the benefits outweigh the risks and harms. But not looking long term, when they've been doing this since 2007....? The hope should be checked by now!
Also her suggestion of pooling the expert opinions--that is WPATH and that doesn't protect the patients. That is why people use evidence based medicine--expert opinion is too prone to bias and patient harm, in this case the bias of "let's keep doing what we were doing until we find out more but we haven't found out more and it's been 17 years...."
I was curious to hear about WPATH commissioning a review from John Hopkins and then ignoring it? Can anyone tell me more about this?
This is Baker et al., 2021, https://academic.oup.com/jes/article-abstract/5/4/bvab011/6126016
And Block, 2023, Gender dysphoria in young people is rising—and so is professional disagreement, https://doi.org/10.1136/bmj.p382 details it.
Thank you. I had only heard of the Florida review as the only systematic review having taken place in the US. That article by Block is very good, thank you.
Thank you, as always, to both of you for putting these in briefs together. Chakrabarti’s interview with Cass on WBUR was an extraordinary breath of fresh air, wasn’t it? Chakrabarti, as Cass noted at one point, was extremely well prepared. She asked intelligent questions to which Cass gave thoughtful, informative answers. This is the journalism we have needed, and I hope we will see more, including LISA in the New York Times, for heaven’s sake!
I do want to caution, on the May 5 entry, “New York Public School passes an anti-transgender sports resolution,” that this headline, as well as the paragraph from the article, is extremely biased in ways we all know. This is a very important issue in NYC, where parents are simply trying to get NYC public schools to conduct a review of public school guidelines on gender as they relate to girls sports. You can read the resolution here: https://drive.google.com/file/d/1ygeLcQW4loVaAkXz7zKftye7HyspJzGe/view Though the resolution from CEC2 passed 8-3, those voting in favor have been harassed and worse, including by Manhatttan Borough President, Mark Levine. You can read about that here: https://www.westsidespirit.com/news-alert-section/cb5-in-revolt-against-boro-pres-mark-levine-fires-off-letter-urging-rescind-craig-slutzkin-s-ouster-ED3353699 and here: https://nypost.com/2024/04/20/us-news/parent-volunteers-face-retaliation-following-gender-policy-vote/
I know how hard it is to put these in briefs together, but to the extent possible, I do recommend having antennae up for poor and biased reporting. For example, a piece like this, which gives Chase Strangio at the ACLU such fulsome coverage needs to be a red flag.
Thank You!
Thank you!!
I was told by someone who read the on point interview that the two US clinicians sounded like "the UK had problems but we are careful"--I am now trying to emphasize that the "careful" US clinicians are not doing what the UK is doing.
The UK is doing no puberty blockers outside of carefully regulated studies (and there isn't one right now), so I think that is IRB human subject protection study level (the US studies don't always meet this I hear).
Cass recommended giving hormones only with "extreme caution." And a clinician can't make the call on their own. "There should be a clear clinical rationale for providing hormones at this stage rather than waiting until an individual reaches 18. Every case considered for medical treatment should be discussed at a national Multi- Disciplinary Team (MDT)."
The US caution looks like doing assessments but as Chakrabarti pointed out:
" That is so remarkable. We don't even know yet what the best assessments are, let alone we don't have an evidence base to know what the best treatments are."
Dr. Tishelman's suggestion that there is research (she is part of Chen et al 2023 which didn't release 6 of the 8 outcomes they said they'd release, where FTM only had small benefit and MTF had no benefit and 2 of the 315 died of suicide)--until there is research they could just stop prescribing for now. Saying they don't know and have to be careful--that might be fine when there are only a few patients a year but now the country is starting 1000's a year on these drugs. The argument that it is too late to be careful...no one should be buying that.
They are providing these interventions without the patients having protections research subjects have. This isn't a case of "we have to do something" as these are physically healthy young people in distress--doing drastic lifelong changes on their physical bodies which are harmful (anyone coming in with those hormone levels who wasn't treating GD would have them treated medically for health reasons!) is happening because the hope is that the benefits outweigh the risks and harms. But not looking long term, when they've been doing this since 2007....? The hope should be checked by now!
Also her suggestion of pooling the expert opinions--that is WPATH and that doesn't protect the patients. That is why people use evidence based medicine--expert opinion is too prone to bias and patient harm, in this case the bias of "let's keep doing what we were doing until we find out more but we haven't found out more and it's been 17 years...."