3 ms·

The Cass report in the UK was pretty clear that there isn't enough evidence to base decisions on https://cass.independent-review.uk/home/publications/final-repo

The Cass report in the UK was pretty clear that there isn't enough evidence to base decisions on https://cass.independent-review.uk/home/publications/final-report/ https://cass.independent-review.uk/home/publications/final-r... >>> While a considerable amount of research has been published in this field, systematic evidence reviews demonstrated the poor quality of the published studies, meaning there is not a reliable evidence base upon which to make clinical decisions, or for children and their families to make informed choices. The strengths and weaknesses of the evidence base on the care of children and young people are often misrepresented and overstated, both in scientific publications and social debate. The controversy surrounding the use of medical treatments has taken focus away from what the individualised care and treatment is intended to achieve for individuals seeking support from NHS gender services. The rationale for early puberty suppression remains unclear, with weak evidence regarding the impact on gender dysphoria, mental or psychosocial health. The effect on cognitive and psychosexual development remains unknown. The use of masculinising / feminising hormones in those under the age of 18 also presents many unknowns, despite their longstanding use in the adult transgender population. The lack of long-term follow-up data on those commencing treatment at an earlier age means we have inadequate information about the range of outcomes for this group.

foldr 2y ago
The report basically said that there wasn't a lot of evidence that the treatments in question make people happy in the long run, which is an unusual standard to apply. Usually we look for evidence that medical treatments achieve their medical goals, and leave judgments about what will or won't make someone happy to doctors or patients. (For example, it's questionable whether certain cancer treatments that extend life by only a few months will be a net benefit for patients, but we generally let patients and doctors decide for themselves whether or not to go ahead with them.)
- in_a_hole 2y ago
  Given that the treatments are meant to address gender dysphoria which is unhappiness caused by a sense of misalignment with one's sexual characteristics I struggle to think of a better measure of success than long-term happiness.
  - foldr 2y ago
    It's a good measure of success, but if we applied the same standard consistently, then all kinds of treatments for all kinds of partially psychological conditions would have to be thrown out. Also, it's taking a particular position to characterise gender dysphoria as merely a subjective feeling of unhappiness. I do not have any fixed position on what exactly gender dysphoria is, but I believe many trans people see it as far more than just that.
nemomarx 2y ago
The Cass report is pretty questionable quality wise - it was written with political goals pretty directly in mind and it rules out a lot of studies for not being double blind. (Which is necessarily a hard ask here, medical ethics boards aren't going to let you give hormones to the control group children or anything.) And that criticism has come from medical boards in the UK and globally, I believe? Anyway, that's also only for children, which feels politically like a wedge issue. The NHS is very slow at providing HRT and I rather doubt they're treating more than a hundred children for gender dysphoria in any way rn.
- sso_eol 2y ago
  > and it rules out a lot of studies for not being double blind Sorry but you're repeating disinformation that has already been refuted by the lead author, and is obviously incorrect if you read the Review itself. http://archive.today/ea0Vi http://archive.today/ea0Vi > Dr Hilary Cass, 66, told The Times last week that one activist had begun posting falsehoods about her landmark review of the treatment of trans children before it was even published. > She was referring to Alejandra Caraballo, an American attorney, transgender woman and instructor at Harvard Law School’s Cyberlaw Clinic. > On April 9 — the day before the Cass review was published — Caraballo claimed it had “disregarded nearly all studies” because they were not double-blind controlled ones. > Double-blind studies see patients randomly given either medicine or a placebo, with neither the patient or doctor knowing which. > In a post on Twitter/X, Caraballo accused Cass and the review team of holding trans healthcare to an “impossible standard”. This was because, she said, transgender patients could not take hormones “blind”, as the effects of any hormones would fairly quickly become obvious. > Her tweets were contradicted by the publication of the Cass review hours later. > During a systematic review, researchers looking at studies on transgender healthcare found no blind control ones — so used another system altogether to determine study quality. Cass told The Times last week how difficult it would be to use blind control studies in relation to trans patients, for the same reasons identified by Caraballo. > As for Caraballo’s claim that the review team “disregarded nearly all studies”, Cass pointed out that 60 out of 103 studies reviewed were used for the conclusions. They were studies deemed to be of moderate and high quality on the effects of puberty blockers and hormone treatment. > Despite this, Caraballo’s post has been viewed 871,000 times and has not been deleted. This is unfortunately quite a typical tactic of activists like Caraballo. They will deliberately lie to further their aims, relying on people who are unaware that their lies are lies to spread this disinformation.

foldr 2y ago

The report basically said that there wasn't a lot of evidence that the treatments in question make people happy in the long run, which is an unusual standard to apply. Usually we look for evidence that medical treatments achieve their medical goals, and leave judgments about what will or won't make someone happy to doctors or patients. (For example, it's questionable whether certain cancer treatments that extend life by only a few months will be a net benefit for patients, but we generally let patients and doctors decide for themselves whether or not to go ahead with them.)

in_a_hole 2y ago
Given that the treatments are meant to address gender dysphoria which is unhappiness caused by a sense of misalignment with one's sexual characteristics I struggle to think of a better measure of success than long-term happiness.
- foldr 2y ago
  It's a good measure of success, but if we applied the same standard consistently, then all kinds of treatments for all kinds of partially psychological conditions would have to be thrown out. Also, it's taking a particular position to characterise gender dysphoria as merely a subjective feeling of unhappiness. I do not have any fixed position on what exactly gender dysphoria is, but I believe many trans people see it as far more than just that.

nemomarx 2y ago

The Cass report is pretty questionable quality wise - it was written with political goals pretty directly in mind and it rules out a lot of studies for not being double blind. (Which is necessarily a hard ask here, medical ethics boards aren't going to let you give hormones to the control group children or anything.) And that criticism has come from medical boards in the UK and globally, I believe? Anyway, that's also only for children, which feels politically like a wedge issue. The NHS is very slow at providing HRT and I rather doubt they're treating more than a hundred children for gender dysphoria in any way rn.

sso_eol 2y ago
> and it rules out a lot of studies for not being double blind Sorry but you're repeating disinformation that has already been refuted by the lead author, and is obviously incorrect if you read the Review itself. http://archive.today/ea0Vi http://archive.today/ea0Vi > Dr Hilary Cass, 66, told The Times last week that one activist had begun posting falsehoods about her landmark review of the treatment of trans children before it was even published. > She was referring to Alejandra Caraballo, an American attorney, transgender woman and instructor at Harvard Law School’s Cyberlaw Clinic. > On April 9 — the day before the Cass review was published — Caraballo claimed it had “disregarded nearly all studies” because they were not double-blind controlled ones. > Double-blind studies see patients randomly given either medicine or a placebo, with neither the patient or doctor knowing which. > In a post on Twitter/X, Caraballo accused Cass and the review team of holding trans healthcare to an “impossible standard”. This was because, she said, transgender patients could not take hormones “blind”, as the effects of any hormones would fairly quickly become obvious. > Her tweets were contradicted by the publication of the Cass review hours later. > During a systematic review, researchers looking at studies on transgender healthcare found no blind control ones — so used another system altogether to determine study quality. Cass told The Times last week how difficult it would be to use blind control studies in relation to trans patients, for the same reasons identified by Caraballo. > As for Caraballo’s claim that the review team “disregarded nearly all studies”, Cass pointed out that 60 out of 103 studies reviewed were used for the conclusions. They were studies deemed to be of moderate and high quality on the effects of puberty blockers and hormone treatment. > Despite this, Caraballo’s post has been viewed 871,000 times and has not been deleted. This is unfortunately quite a typical tactic of activists like Caraballo. They will deliberately lie to further their aims, relying on people who are unaware that their lies are lies to spread this disinformation.