5 ms·

Researchers Found Puberty Blockers Didn’t Improve Trans Kids’ Mental Health

57 points by jimbob45 5y ago

dsjoerg 5y ago
OMG thank you for highlighting this. Everyone who cares about doing the right thing should want real science to be done here.
mzvkxlcvd 5y ago
this will be looked back at in the same way as Lobotomies a few years from now
- nullc 5y ago
  At least the people who've been lobotomized can't complain later that it wasn't a good idea.
- naoqj 5y ago
  Not only using puberty blockers but mutilating children in general.
  - Overtonwindow 5y ago
    A concern I've always had with gender affirming treatments is that there's a strong belief that it is a medical condition, and not a psychiatric problem. I'm not a doctor or anything like that, but it seems to be very much a psychological issue, not a medical issue. Hormone treatment, surgeries, etc. are like medication to cover up the symptoms, but unless mental health is introduced to treat the psychological side, I don't think persons will find relief.
    - Bancakes 5y ago
      Society has to reward people not for 'being' but for 'doing'. Two genders, two sexes, zero choices. You're right it's a psychiatric problem. People simply cannot ask themselves: "Is what I'm doing constructive or destructive?"
    - Ekaros 5y ago
      I'm not in mind that there isn't some subset of population that would not benefit from these treatments. What I question is how large it actually is and how big is effect of peer pressure, media trendiness and in general being teenager going through puberty have. Or just children being children. In some ways there might even be over emphasis of gender roles with momentary interest of children. Now hard part is how to solve these issues without invasive actions and how to separate those who could benefit from such.
- ejang0 5y ago
  I will remind the gentle reader that the originator of the lobotomy was awarded a Nobel Prize for this. From Wikipedia: "The originator of the procedure, Portuguese neurologist António Egas Moniz, shared the Nobel Prize for Physiology or Medicine of 1949 for the "discovery of the therapeutic value of leucotomy in certain psychoses", although the awarding of the prize has been subject to controversy."
temptemptemp111 5y ago
[dead]
s_kilk 5y ago
@dang, can you do something about the flagrant bigotry contaminating this board?
- newsclues 5y ago
  It’s not bigotry to discuss facts, and people who hide child abuse with the claim that it is bigotry are child abusers who ought to have their crimes published and prosecuted under the law.
- dwringer 5y ago
  You can just flag submissions or click the "<x> minutes ago" to open individual comments and flag them.
- _-david-_ 5y ago
  I'm a bit confused how there is any bigotry involved. If puberty blockers do not solve some issues then they do not solve the issues.
  - newsclues 5y ago
    It’s activists who call facts they disagree with bigotry.
    - slothtrop 5y ago
      lo and behold, the thread is flagged.
- phnofive 5y ago
  I'd suggest emailing hn@ycombinator.com for any official response.
- cpach 5y ago
  Can you be more specific?
- Bancakes 5y ago
  >@dang, can you help me rebuild my shell so I can hide again?
tofuahdude 5y ago
Note that the linked article is a critique of the underlying study.
deleted 5y ago
[deleted]
readyplayeremma 5y ago
The actual concern raised, buried in the article (which is itself only a commentary on a different study): "So the action here, as the researcher admits, comes not from the kids in the treatment group getting better, but rather from the kids in the comparison group getting worse." Isn't that how control groups are supposed to work? Your treatment should produce better outcomes than the lack of treatment. This appears to correctly be the case here. The fact that these treatments alone don't resolve gender dysphoria, is expected, they are one part of a process. Stopping a rapid decline is one huge step in the right direction.
- zozbot234 5y ago
  A proper control group should be defined as the state-of-the-art alternative, not as "no treatment". The latter is a common ploy used to push substandard, "me too" treatments.
  - temp8964 5y ago
    Shouldn't the control group get placebo treatment? Simply by knowing they have been "treated" could already make them feel better. When the effect you are looking for is a psychological effect, it is even more serious a research design problem.
  - lupire 5y ago
    what is the state of the art alternative, for this?
  - notahacker 5y ago
    What's the "state of the art alternative" to address gender dysphoria in adolescents? Certainly the alternative to puberty blockers or hormones most often advocated is doing nothing. The author makes some perfectly reasonable points about flaws in the study like the large and uneven number of dropouts from the study, likelihood of confounding factors in the nonrandom selection process and oddities in its construction to the extent I'm not sure the study itself can be used as firm evidence of anything, but his insistence that the treatment group not getting worse like the control group can't be evidence for it being beneficial isn't justified either.
awb 5y ago
> “[W]hen we adjusted our models for receipt of PB/GAH [that is, puberty blockers and gender-affirming hormones] we saw that depression and suicidality significantly worsened among youth who had not (yet) started PB/GAH at 3 and 6 months relative to baseline levels.” So the action here, as the researcher admits, comes not from the kids in the treatment group getting better, but rather from the kids in the comparison group getting worse. This is a bit of a perspective argument. According to the small study that was conducted, treatment kept mental health the same, while it declined for those that went without treatment. Pertinent data table: https://cdn.substack.com/image/fetch/w_1456,c_limit,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F51f3f30b-525b-42a0-a655-e059ce5a85df_1001x260.png https://cdn.substack.com/image/fetch/w_1456,c_limit,f_webp,q... So, it's more of a semantic argument. Did it really improve mental health? Relative to where they were at the start of the trial, no. Relative to the decline in the control group, yes.
- _-david-_ 5y ago
  Many kids in the control group dropped out. This left the kids who did not improve in the control group >The vast majority of kids who dropped out of this study didn’t access GAM. By the end of the study, just 6/63 of the remaining kids who provided mental health data, or 9.5% of the study participants, were in the no-GAM group. Overall, according to the researchers’ data, 12/69 (17.4%) of the kids who were treated left the study, while 28/35 (80%) of the kids who weren’t treated left it If the study had continued to get details from all the kids we probably would not have seen an improvement compared to the control group.
  - temp8964 5y ago
    With this kind of attrition rate, I am impressed that the researchers dared to write it up and got it published ... Then I found it was published on "JAMA Network Open", is it even a serious journal?
  - awb 5y ago
    > If the study had continued to get details from all the kids we probably would not have seen an improvement compared to the control group. Why do you assume the control group kids that dropped out would have caused the data to trend in a positive direction? Was there data on why they dropped out?
dmwallin 5y ago
This article's title is disingenuous and is guilty of the same thing it accuses the study of. The actual content of this article is the following (TLDR) 1) That the study didn't show a reduction in negative health outcomes, rather the control group showed an increase in negative outcomes. 2) The author of the article disagrees that this is equivalent to the stated claim, and offers a number of alternative explanations why you might see this outcome in the data 3) The author offers some critiques around lack of data transparency and the statistical rigor of the study. In the end the title is a semantic nitpick around the difference between "improved absolute health" and "improved relative health outcomes" and not the smoking gun of bad faith actors it implies.

57 points by jimbob45 5y ago

OMG thank you for highlighting this. Everyone who cares about doing the right thing should want real science to be done here.

mzvkxlcvd 5y ago

this will be looked back at in the same way as Lobotomies a few years from now

nullc 5y ago
At least the people who've been lobotomized can't complain later that it wasn't a good idea.
naoqj 5y ago
Not only using puberty blockers but mutilating children in general.
- Overtonwindow 5y ago
  A concern I've always had with gender affirming treatments is that there's a strong belief that it is a medical condition, and not a psychiatric problem. I'm not a doctor or anything like that, but it seems to be very much a psychological issue, not a medical issue. Hormone treatment, surgeries, etc. are like medication to cover up the symptoms, but unless mental health is introduced to treat the psychological side, I don't think persons will find relief.
  - Bancakes 5y ago
    Society has to reward people not for 'being' but for 'doing'. Two genders, two sexes, zero choices. You're right it's a psychiatric problem. People simply cannot ask themselves: "Is what I'm doing constructive or destructive?"
  - Ekaros 5y ago
    I'm not in mind that there isn't some subset of population that would not benefit from these treatments. What I question is how large it actually is and how big is effect of peer pressure, media trendiness and in general being teenager going through puberty have. Or just children being children. In some ways there might even be over emphasis of gender roles with momentary interest of children. Now hard part is how to solve these issues without invasive actions and how to separate those who could benefit from such.
ejang0 5y ago
I will remind the gentle reader that the originator of the lobotomy was awarded a Nobel Prize for this. From Wikipedia: "The originator of the procedure, Portuguese neurologist António Egas Moniz, shared the Nobel Prize for Physiology or Medicine of 1949 for the "discovery of the therapeutic value of leucotomy in certain psychoses", although the awarding of the prize has been subject to controversy."

temptemptemp111 5y ago

[dead]

s_kilk 5y ago

@dang, can you do something about the flagrant bigotry contaminating this board?

newsclues 5y ago
It’s not bigotry to discuss facts, and people who hide child abuse with the claim that it is bigotry are child abusers who ought to have their crimes published and prosecuted under the law.
dwringer 5y ago
You can just flag submissions or click the "<x> minutes ago" to open individual comments and flag them.
_-david-_ 5y ago
I'm a bit confused how there is any bigotry involved. If puberty blockers do not solve some issues then they do not solve the issues.
- newsclues 5y ago
  It’s activists who call facts they disagree with bigotry.
  - slothtrop 5y ago
    lo and behold, the thread is flagged.
phnofive 5y ago
I'd suggest emailing hn@ycombinator.com for any official response.
cpach 5y ago
Can you be more specific?
Bancakes 5y ago
>@dang, can you help me rebuild my shell so I can hide again?

tofuahdude 5y ago

Note that the linked article is a critique of the underlying study.

deleted 5y ago

[deleted]

readyplayeremma 5y ago

The actual concern raised, buried in the article (which is itself only a commentary on a different study): "So the action here, as the researcher admits, comes not from the kids in the treatment group getting better, but rather from the kids in the comparison group getting worse." Isn't that how control groups are supposed to work? Your treatment should produce better outcomes than the lack of treatment. This appears to correctly be the case here. The fact that these treatments alone don't resolve gender dysphoria, is expected, they are one part of a process. Stopping a rapid decline is one huge step in the right direction.

zozbot234 5y ago
A proper control group should be defined as the state-of-the-art alternative, not as "no treatment". The latter is a common ploy used to push substandard, "me too" treatments.
- temp8964 5y ago
  Shouldn't the control group get placebo treatment? Simply by knowing they have been "treated" could already make them feel better. When the effect you are looking for is a psychological effect, it is even more serious a research design problem.
- lupire 5y ago
  what is the state of the art alternative, for this?
- notahacker 5y ago
  What's the "state of the art alternative" to address gender dysphoria in adolescents? Certainly the alternative to puberty blockers or hormones most often advocated is doing nothing. The author makes some perfectly reasonable points about flaws in the study like the large and uneven number of dropouts from the study, likelihood of confounding factors in the nonrandom selection process and oddities in its construction to the extent I'm not sure the study itself can be used as firm evidence of anything, but his insistence that the treatment group not getting worse like the control group can't be evidence for it being beneficial isn't justified either.

awb 5y ago

> “[W]hen we adjusted our models for receipt of PB/GAH [that is, puberty blockers and gender-affirming hormones] we saw that depression and suicidality significantly worsened among youth who had not (yet) started PB/GAH at 3 and 6 months relative to baseline levels.” So the action here, as the researcher admits, comes not from the kids in the treatment group getting better, but rather from the kids in the comparison group getting worse. This is a bit of a perspective argument. According to the small study that was conducted, treatment kept mental health the same, while it declined for those that went without treatment. Pertinent data table: https://cdn.substack.com/image/fetch/w_1456,c_limit,f_webp,q_auto:good,fl_progressive:steep/https%3A%2F%2Fbucketeer-e05bbc84-baa3-437e-9518-adb32be77984.s3.amazonaws.com%2Fpublic%2Fimages%2F51f3f30b-525b-42a0-a655-e059ce5a85df_1001x260.png https://cdn.substack.com/image/fetch/w_1456,c_limit,f_webp,q... So, it's more of a semantic argument. Did it really improve mental health? Relative to where they were at the start of the trial, no. Relative to the decline in the control group, yes.

_-david-_ 5y ago
Many kids in the control group dropped out. This left the kids who did not improve in the control group >The vast majority of kids who dropped out of this study didn’t access GAM. By the end of the study, just 6/63 of the remaining kids who provided mental health data, or 9.5% of the study participants, were in the no-GAM group. Overall, according to the researchers’ data, 12/69 (17.4%) of the kids who were treated left the study, while 28/35 (80%) of the kids who weren’t treated left it If the study had continued to get details from all the kids we probably would not have seen an improvement compared to the control group.
- temp8964 5y ago
  With this kind of attrition rate, I am impressed that the researchers dared to write it up and got it published ... Then I found it was published on "JAMA Network Open", is it even a serious journal?
- awb 5y ago
  > If the study had continued to get details from all the kids we probably would not have seen an improvement compared to the control group. Why do you assume the control group kids that dropped out would have caused the data to trend in a positive direction? Was there data on why they dropped out?

dmwallin 5y ago

This article's title is disingenuous and is guilty of the same thing it accuses the study of. The actual content of this article is the following (TLDR) 1) That the study didn't show a reduction in negative health outcomes, rather the control group showed an increase in negative outcomes. 2) The author of the article disagrees that this is equivalent to the stated claim, and offers a number of alternative explanations why you might see this outcome in the data 3) The author offers some critiques around lack of data transparency and the statistical rigor of the study. In the end the title is a semantic nitpick around the difference between "improved absolute health" and "improved relative health outcomes" and not the smoking gun of bad faith actors it implies.