Thank you, Lisa. May it be widely reported, and make a real difference, here. Azeen Ghoryashi includes this quote from Dr Cass, and a link to Cass' interview with the BMJ:
“Children and young people have just been really poorly served,” Dr. Cass said in an interview with the editor of The British Medical Journal, released Tuesday. She added, “I can’t think of another area of pediatric care where we give young people potentially irreversible treatments and have no idea what happens to them in adulthood.”
Thanks Lisa, for this conversation I wondered about the this sentence "This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint." I have seen many times where the TRAs misrepresent studies that do not show positive outcomes, but how often is it the other side? Gender medicine critics who look at studies showing positive outcomes but misrepresent those?
In that same vein, what should the standard be to allow use of puberty blockers or cross-sex hormones? I see the Endocrine Society warning about plastics interfering in natural hormonal processes on one hand, but then advocate for medications that intentionally interfere with those processes on the other. Is it even possible for those interventions to have a positive effect outside of something on the mental side of care? Personally I think the bar would need to be WAY higher to justify those interventions, even in adults.
Well, low quality evidence doesn't mean the evidence is wrong. It means that it's impossible to know if it will apply, right? And thus, one should proceed with extreme caution. usually it means: opt for the least invasive treatment. But as I learned from SEGM, it also means deferring to the patient's values and preferences. It doesn't mean "don't ever do it." Lots of medicine has only low-quality research and we do it anyway. Of course, perhaps nothing as deeply invasive as this, and nothing that is pitched to children as a panacea...
Yeah, the more I watch gender clinicians talk about their work the more I notice that theme - when discussing some challenge or negative side effect or lack of indications or evidence base for a particular treatment, they tend to shrug and say "but that's what they want, so....".
Thanks Lisa, I guess I have been struggling through (i.e. getting even more furious) after reading the WPATH files. In Mia's last section when she discusses other medical scandals, she mentioned ovariotomies in the 19th century. We know that removing women's ovaries has no medical impact on mental issues, but that did not stop some women from claiming that they were "healed" by the procedure. But there is no medical pathway for that to happen. It had to be completely a placebo effect -- only in the mind.
Consider SSRIs. Whether or not you believe they are a good idea, at least I know that there is a physical mechanism there -- serotonin that would seep back into the brain is prevented from doing so with SSRIs. Outside of the trans world, if there is an unproven experimental medicine for a chronic physical illness, at least there would typically be a hypothesis behind it as to why it might work. Even then I know some approved medicines -- e.g. Ozempic -- are not clear as to how they work (which frankly scares me enough not to try it).
For gender medicine, I don't see any actual medical benefit beyond "Oh, they just feel better and will not kill themselves". Sure, testosterone for a girl will give her a temporary rush, and yeah it is used by some 50-year old men for a similar feeling. There is just something where I struggle in my mind as to the differences. For T in girls, we are seeing poor effects already and I think we will see more. I personally am disgusted with any removal of healthy breasts from a young woman -- hard stop. But an adult woman who wants breast enhancements does not elicit that response. I still think it is too centered on a unhealthy perception of beauty and human value -- in keeping with your SEGM note -- but disappointment there would be far less traumatic, but maybe I am wrong. At any rate, thanks for your thoughts.
The supposed main benefit of "gender medicine" to prevent puberty is that its necessarily young recipients will later "pass" better as the apparently opposite sex, than those (previously mainly male) who have gone through puberty. So it's very much an issue of appearance: that goes beyond clothes to reshaping bodies.
It still boggles my mind that the Dutch Protocol clinicians completely ignored the question of what these kids would be giving up physiologically by not going through normal puberty.
Unlike previous studies, this one controlled for sexual orientation. Once that was accounted for, the brains of pre-HST trans-identified people were shown to be no different than others of their sex.
The implication of course being, that it's homosexuality that is a bit innate, and trans only appears to be by virtue of its association with it.
In the 60's/70's when it was ONLY JHU operating as a gender clinic performing surgeries, the surgical portion was closed because a systematic review was done and found no evidence that surgeries helped psychologically. Dr. Paul McHugh stated in 2016 that transsexualism is a disorder of "assumption" just as anorexia is. Medicalizing "trans" should be dealt with differently.
Yes. And the objective evidence, like clinical diagnoses, psych med prescriptions and episodes of hospitalization, showed no psychological improvement despite the patients' insistence that they were doing better.
This highlights the absurdity of judging the effectiveness of medical transition by asking the patient how they're feeling. It's part of their mental illness to believe that transition will solve all of their problems, and admitting that it didn't work would be admitting that they mutilated themselves needlessly. So of course there is a gargantuan bias on their part toward saying they're doing better.
It's especially important to note this in light of the fact that all of the evidence in favor of transition is based on these self-assessments.
In a typical study of this nature, the transitioning subjects fill out a multiple-choice questionnaire including questions about how they've been feeling and thoughts they've been having, at the beginning of the study, at the end of the study, and possibly in the middle one or more times as well, depending on its length.
So of course they're going to report feeling better at the end 🙄 especially since transitioners report an initial feeling of euphoria when they finally, after a wait sometimes of years, start transitioning.
This is also why the short-term studies tend to favor positive results while the longer-term followups don't.
Absolutely. These kids are being convinced they’re trans by online influencers. And this is not a popular thing to say, but I also think some of them are being convinced they’re gay or bi.
Agreed. But I think its more complex than just being influenced. The way kids brain and social development is being altered leaves some very suceptible to anything that will fill the void. In otherwords its not just normal kids being influenced inline, the "hole" is created first, then it gets filled. All in all a very efficient system actually. Couldnt have designed it better
I think we are creating cluster B personality traits in kids. Borderline traits. Im not saying we are creating the "disorder" which has a genetic and temparament predisposition, but I am suggesting we are creating those traits of bottomless pit despair.
I think ptobably the most concise rundown of the bulk of the problem is in Jonathan Haidts new book The Anxious Generation. Here's a summary for parents. I just skimmed the article briefly.
Basically we are giving the wrong inputs during brain development in children ...for profit. At the same time parenting, as a society (parents, school, therapy, etc) has weakened their defenses.
Children can no more "consent" to have their healthy breasts and genitalia removed or take puberty blockers than they can
"consent" to have sex with an adult.
Similarly, parents and doctors can no more approve such permanent mutilation simply because a minor child desires it than they can approve pedophilia.
Ultimately society will see the truth and ban the practice as we have banned female genital mutilation. Do people support that practice if the parents consent? I truly hope not
It is monstrous to believe otherwise and those who do will ultimately be held to account for their actions.
To whom you are attracted sexually is purely subjective and therefore cannot reasonably be contested by an outside observer. Where you decide to live your life on a spectrum of superficial, stereotypical male to female attributes (and we all do) is also purely subjective and similarly cannot be questioned. However, your biological sex reflects an objective reality which cannot be changed by your subjective personal view and futile attempts to do so can result in serious health impacts to you as well as actual harms to members of the sex you are impersonating (especially women). Finally, others who are grounded in objective reality should never be forced to accept your subjective version of your actual biological sex.
I think thats the point though. Placing "trans" squarely in the mental health arena allows for the argument that its a belief system, a religious fever, a social contagion. To the person experiencing "trans" its very real. Just as the experience of being "saved" and speaking in tongues is very real to those people. The rest of us know they are batshit crazy.
I think in very short order, if medicalization is taken away from kids as a means to control adults, even they will start to de-fantacize about it.
I think its right to treat this with a ton of empathy for those caught in it because the fallout is going to be almost unbearable. I lose sleep over this. I think we will see more suicides from realizing what we've done than we ever did from "transphobia". Those people need compassion.
Who places "trans" squarely in the "mental health" arena?
Your comment doesn't make sense. No one is placing it in the "mental health" arena but if they were, that would not allow for the argument that it's a belief system. I don't understand how you get from A to B.
You are making baseless claims. Where is the evidence for your claim that "to the person experience "trans" it's very real"?
"Trans" is not defined, but the government tells us it's a thing and it puts you above the law and allows you to always be seen as a victim and never an offender. Might people claim they are "trans" for all the benefits and advantages that confers?
You are really gullible to believe and accept without question what people claim about their feelings. People make all sorts of claims about all sorts of things, including their own beliefs and their own feelings. They often lie about both.
I agree with you as to the fact. To the judgement....it's unfortunate but it just won't be effective to tell the undecided or persuadable folks the whole truth right away that the whole thing is insane and evil.
KJK's take is right on. "A limp salad version of the truth." 😂
And closing the Tavistock might seem good, but transferring child gender services to the existing adult clinics? The ones that mostly refused to cooperative with Cass's review? That is not good. Those people are not going to be "cautious", and they're going to try to hide what they're doing from the public and the authorities until a sympathetic government takes over.
We have won a very small battle; a huge war remains to be fought.
Thank you, Lisa. May it be widely reported, and make a real difference, here. Azeen Ghoryashi includes this quote from Dr Cass, and a link to Cass' interview with the BMJ:
“Children and young people have just been really poorly served,” Dr. Cass said in an interview with the editor of The British Medical Journal, released Tuesday. She added, “I can’t think of another area of pediatric care where we give young people potentially irreversible treatments and have no idea what happens to them in adulthood.”
Thanks Lisa, for this conversation I wondered about the this sentence "This is an area of remarkably weak evidence, and yet results of studies are exaggerated or misrepresented by people on all sides of the debate to support their viewpoint." I have seen many times where the TRAs misrepresent studies that do not show positive outcomes, but how often is it the other side? Gender medicine critics who look at studies showing positive outcomes but misrepresent those?
In that same vein, what should the standard be to allow use of puberty blockers or cross-sex hormones? I see the Endocrine Society warning about plastics interfering in natural hormonal processes on one hand, but then advocate for medications that intentionally interfere with those processes on the other. Is it even possible for those interventions to have a positive effect outside of something on the mental side of care? Personally I think the bar would need to be WAY higher to justify those interventions, even in adults.
Well, low quality evidence doesn't mean the evidence is wrong. It means that it's impossible to know if it will apply, right? And thus, one should proceed with extreme caution. usually it means: opt for the least invasive treatment. But as I learned from SEGM, it also means deferring to the patient's values and preferences. It doesn't mean "don't ever do it." Lots of medicine has only low-quality research and we do it anyway. Of course, perhaps nothing as deeply invasive as this, and nothing that is pitched to children as a panacea...
Yeah, the more I watch gender clinicians talk about their work the more I notice that theme - when discussing some challenge or negative side effect or lack of indications or evidence base for a particular treatment, they tend to shrug and say "but that's what they want, so....".
Thanks Lisa, I guess I have been struggling through (i.e. getting even more furious) after reading the WPATH files. In Mia's last section when she discusses other medical scandals, she mentioned ovariotomies in the 19th century. We know that removing women's ovaries has no medical impact on mental issues, but that did not stop some women from claiming that they were "healed" by the procedure. But there is no medical pathway for that to happen. It had to be completely a placebo effect -- only in the mind.
Consider SSRIs. Whether or not you believe they are a good idea, at least I know that there is a physical mechanism there -- serotonin that would seep back into the brain is prevented from doing so with SSRIs. Outside of the trans world, if there is an unproven experimental medicine for a chronic physical illness, at least there would typically be a hypothesis behind it as to why it might work. Even then I know some approved medicines -- e.g. Ozempic -- are not clear as to how they work (which frankly scares me enough not to try it).
For gender medicine, I don't see any actual medical benefit beyond "Oh, they just feel better and will not kill themselves". Sure, testosterone for a girl will give her a temporary rush, and yeah it is used by some 50-year old men for a similar feeling. There is just something where I struggle in my mind as to the differences. For T in girls, we are seeing poor effects already and I think we will see more. I personally am disgusted with any removal of healthy breasts from a young woman -- hard stop. But an adult woman who wants breast enhancements does not elicit that response. I still think it is too centered on a unhealthy perception of beauty and human value -- in keeping with your SEGM note -- but disappointment there would be far less traumatic, but maybe I am wrong. At any rate, thanks for your thoughts.
The supposed main benefit of "gender medicine" to prevent puberty is that its necessarily young recipients will later "pass" better as the apparently opposite sex, than those (previously mainly male) who have gone through puberty. So it's very much an issue of appearance: that goes beyond clothes to reshaping bodies.
It still boggles my mind that the Dutch Protocol clinicians completely ignored the question of what these kids would be giving up physiologically by not going through normal puberty.
As we're finding out, it's a whole lot.
Yes, I wonder how those clinicians are feeling about that now the damaging effects of their experimental medication are being identified.
I suppose breast implants are different because they are reversible unlike mastectomies.
Yep.
Re: gender & sexuality not being separate, that link was also articulated by the brain study which debunked the "trans brain" hypothesis.
https://www.nature.com/articles/s41598-017-17352-8
Unlike previous studies, this one controlled for sexual orientation. Once that was accounted for, the brains of pre-HST trans-identified people were shown to be no different than others of their sex.
The implication of course being, that it's homosexuality that is a bit innate, and trans only appears to be by virtue of its association with it.
In the 60's/70's when it was ONLY JHU operating as a gender clinic performing surgeries, the surgical portion was closed because a systematic review was done and found no evidence that surgeries helped psychologically. Dr. Paul McHugh stated in 2016 that transsexualism is a disorder of "assumption" just as anorexia is. Medicalizing "trans" should be dealt with differently.
Yes. And the objective evidence, like clinical diagnoses, psych med prescriptions and episodes of hospitalization, showed no psychological improvement despite the patients' insistence that they were doing better.
This highlights the absurdity of judging the effectiveness of medical transition by asking the patient how they're feeling. It's part of their mental illness to believe that transition will solve all of their problems, and admitting that it didn't work would be admitting that they mutilated themselves needlessly. So of course there is a gargantuan bias on their part toward saying they're doing better.
It's especially important to note this in light of the fact that all of the evidence in favor of transition is based on these self-assessments.
In a typical study of this nature, the transitioning subjects fill out a multiple-choice questionnaire including questions about how they've been feeling and thoughts they've been having, at the beginning of the study, at the end of the study, and possibly in the middle one or more times as well, depending on its length.
So of course they're going to report feeling better at the end 🙄 especially since transitioners report an initial feeling of euphoria when they finally, after a wait sometimes of years, start transitioning.
This is also why the short-term studies tend to favor positive results while the longer-term followups don't.
And here's Hannah Barnes on BBC 4's Woman's Hour. Worth a listen: https://www.bbc.co.uk/sounds/play/m001y28f
Even Hannah Barnes appears to accept the premise that "gender identity" is something real.
Anybody else see how the rise in trans by sex graph DIRECTLY maps onto Jonathan Haidt and Jean Twenge's social media graphs?
Lisa, my greatest wish is for you to contact Jonathan Haidt to write a guest essay for After Babel.
Absolutely. These kids are being convinced they’re trans by online influencers. And this is not a popular thing to say, but I also think some of them are being convinced they’re gay or bi.
Agreed. But I think its more complex than just being influenced. The way kids brain and social development is being altered leaves some very suceptible to anything that will fill the void. In otherwords its not just normal kids being influenced inline, the "hole" is created first, then it gets filled. All in all a very efficient system actually. Couldnt have designed it better
I agree there is a void. What are your thoughts on that?
I think we are creating cluster B personality traits in kids. Borderline traits. Im not saying we are creating the "disorder" which has a genetic and temparament predisposition, but I am suggesting we are creating those traits of bottomless pit despair.
How do you think we’re doing that?
I think ptobably the most concise rundown of the bulk of the problem is in Jonathan Haidts new book The Anxious Generation. Here's a summary for parents. I just skimmed the article briefly.
Basically we are giving the wrong inputs during brain development in children ...for profit. At the same time parenting, as a society (parents, school, therapy, etc) has weakened their defenses.
https://open.substack.com/pub/katherinemartinko/p/the-anxious-generation-things-are?utm_source=share&utm_medium=android&r=8mb0n
Children can no more "consent" to have their healthy breasts and genitalia removed or take puberty blockers than they can
"consent" to have sex with an adult.
Similarly, parents and doctors can no more approve such permanent mutilation simply because a minor child desires it than they can approve pedophilia.
Ultimately society will see the truth and ban the practice as we have banned female genital mutilation. Do people support that practice if the parents consent? I truly hope not
It is monstrous to believe otherwise and those who do will ultimately be held to account for their actions.
To whom you are attracted sexually is purely subjective and therefore cannot reasonably be contested by an outside observer. Where you decide to live your life on a spectrum of superficial, stereotypical male to female attributes (and we all do) is also purely subjective and similarly cannot be questioned. However, your biological sex reflects an objective reality which cannot be changed by your subjective personal view and futile attempts to do so can result in serious health impacts to you as well as actual harms to members of the sex you are impersonating (especially women). Finally, others who are grounded in objective reality should never be forced to accept your subjective version of your actual biological sex.
The "report" further promulgates the lie that there is such a thing as "being trans."
"This Review is not about defining what it means to be trans, ..."
Utter evil. That's what the "report" is.
I think thats the point though. Placing "trans" squarely in the mental health arena allows for the argument that its a belief system, a religious fever, a social contagion. To the person experiencing "trans" its very real. Just as the experience of being "saved" and speaking in tongues is very real to those people. The rest of us know they are batshit crazy.
I think in very short order, if medicalization is taken away from kids as a means to control adults, even they will start to de-fantacize about it.
I think its right to treat this with a ton of empathy for those caught in it because the fallout is going to be almost unbearable. I lose sleep over this. I think we will see more suicides from realizing what we've done than we ever did from "transphobia". Those people need compassion.
Just my humble opinion
Who places "trans" squarely in the "mental health" arena?
Your comment doesn't make sense. No one is placing it in the "mental health" arena but if they were, that would not allow for the argument that it's a belief system. I don't understand how you get from A to B.
You are making baseless claims. Where is the evidence for your claim that "to the person experience "trans" it's very real"?
"Trans" is not defined, but the government tells us it's a thing and it puts you above the law and allows you to always be seen as a victim and never an offender. Might people claim they are "trans" for all the benefits and advantages that confers?
You are really gullible to believe and accept without question what people claim about their feelings. People make all sorts of claims about all sorts of things, including their own beliefs and their own feelings. They often lie about both.
I agree with you as to the fact. To the judgement....it's unfortunate but it just won't be effective to tell the undecided or persuadable folks the whole truth right away that the whole thing is insane and evil.
Baby steps to start with.
No. Tell the truth.
Pfff. https://www.youtube.com/watch?v=e8T3hQl6EQE
KJK's take is right on. "A limp salad version of the truth." 😂
And closing the Tavistock might seem good, but transferring child gender services to the existing adult clinics? The ones that mostly refused to cooperative with Cass's review? That is not good. Those people are not going to be "cautious", and they're going to try to hide what they're doing from the public and the authorities until a sympathetic government takes over.
We have won a very small battle; a huge war remains to be fought.
Thanks for hopping right on this, and keep it coming, Lisa!