5 ms·

It is certainly not factual to claim that a drug which is safe in treatment X (precocious puberty) is also safe in treatment Y (gender dysphoria). The article c

by jl6 2y ago

It is certainly not factual to claim that a drug which is safe in treatment X (precocious puberty) is also safe in treatment Y (gender dysphoria). The article conflates both as “puberty delaying treatments”, as if the learning from one is completely transferable to the other. It is not. The differences I mentioned are material. The “side” (scare quotes, for there are multiple positions available, not just those that come through the lens of US politics) with the higher quality analysis is that expressed in the Cass Review, which does not call for a ban, but rather for clinical trials and a data linkage study (for which data linking adult outcomes to pediatric gender interventions has so far been withheld by the relevant clinics - draw your own conclusions about why they would not want that to be surfaced).

notahacker 2y ago
The differences may well be material, but as I mentioned in the post above it's simply false to claim SA conflate the two when they link (multiple times) to an article looking at trans people specifically and also mention that they are healthy and safe when prescribed to other young people for other reasons. An article which links to an article discussing outcomes of a drug in young people that also mentions below that it's routinely and uncontroversially prescribed in old people would not be factually inaccurate, even though young people and old people are evidently not identical and it is not impossible the two have different outcomes. The Cass Review itself offers no evidence the blockers are dangerous or inevitably irreversible (or if one takes a less cautious approach, cause patients more problems with irreversibility than not using them), merely finding that only two papers providing evidence for the treatment being safe and optimal were of "high quality" with others being of "moderate" quality or "low" quality and calling for another trial. It did not find higher quality papers drawing opposing conclusions. People more knowledgeable and cynical than me have suggested that treatments for other, less politically-charged but complex conditions may also suffer from the literature that supports clinicians preferred approach being of "moderate" quality but seldom face shutdown as a result. The side that trumpeted this conclusion (because it very much is political, even in the UK) delightedly concluded that as the favourably-disposed evidence mostly fell short of excellence, all gender affirming care must be shut down permanently. Perhaps you view things differently and would very much like to see the new clinics opened and a clinical trial designed to Ms Cass' liking devised, but it's safe to say most of the people trumpeting it as the last word in the debate would not.
- almatabata 2y ago
  When reading the article I do get the impression they try to downplay the potential risks. quote 1: “These puberty-pausing medications are widely used in many different populations and safely so,” McNamara says. quote 2: “From an ethical and a legal perspective, this is a benign medication,” Giordano says. She is puzzled by the extra scrutiny these treatments receive, considering their benefits and limited risks. “There are no sound clinical, ethical or legal reasons for denying them to those in need,” she says. quote 3: Like any medication, GnRHas carry the potential for adverse effects. Now if you read one of the studies they link (https://pmc.ncbi.nlm.nih.gov/articles/PMC7497424/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7497424/). quote: "Arguments against the use of GnRHa that have been raised include possible long-term adverse effects on health, psychological, and sexual functioning (Laidlaw, Cretella, & Donovan, 2019; Richards, Maxwell, & McCune, 2019; Vrouenraets et al., 2015)." I really feel like they overstate the strength of their positions with the articles they cite. All of them show clear limitations of the results which clearly show we need more data.
  - notahacker 2y ago
    I don't think Scientific American are exactly hiding that they hold a position on the issue. But I don't think that they've misrepresented that study, which is an observational study looking for evidence of whether there's any truth to those sorts of arguments (the citations appears to be two letters to the editor and an ethics paper...) which didn't find them, mainly because there weren't many dropouts to study.
- Manuel_D 2y ago
  It absolutely does offer that evidence. Blockers are indeed irreversible, they can lead to infertility and inability to orgasm depending on the length of time they're taken. Even shorter periods of puberty blockers will change height, muscle, and skeletal development. Evidence based medicine doesn't mean that we simply give people treatments unless they're proven to be harmful. It means we don't give treatments unless we know that the effects are positive. The UK is far from alone in pausing medicalization of gender dysphoric children. This is the case throughout pretty much all of the European continent at this point, prescription of puberty blockers and cross sex hormones is either banned or exclusively permitted as part of clinical trials - which means patients are explicitly told that this is experimental treatment, and the outcomes of patients needs to be tracked and published.

by jl6 2y ago

notahacker 2y ago

The differences may well be material, but as I mentioned in the post above it's simply false to claim SA conflate the two when they link (multiple times) to an article looking at trans people specifically and also mention that they are healthy and safe when prescribed to other young people for other reasons. An article which links to an article discussing outcomes of a drug in young people that also mentions below that it's routinely and uncontroversially prescribed in old people would not be factually inaccurate, even though young people and old people are evidently not identical and it is not impossible the two have different outcomes. The Cass Review itself offers no evidence the blockers are dangerous or inevitably irreversible (or if one takes a less cautious approach, cause patients more problems with irreversibility than not using them), merely finding that only two papers providing evidence for the treatment being safe and optimal were of "high quality" with others being of "moderate" quality or "low" quality and calling for another trial. It did not find higher quality papers drawing opposing conclusions. People more knowledgeable and cynical than me have suggested that treatments for other, less politically-charged but complex conditions may also suffer from the literature that supports clinicians preferred approach being of "moderate" quality but seldom face shutdown as a result. The side that trumpeted this conclusion (because it very much is political, even in the UK) delightedly concluded that as the favourably-disposed evidence mostly fell short of excellence, all gender affirming care must be shut down permanently. Perhaps you view things differently and would very much like to see the new clinics opened and a clinical trial designed to Ms Cass' liking devised, but it's safe to say most of the people trumpeting it as the last word in the debate would not.

almatabata 2y ago
When reading the article I do get the impression they try to downplay the potential risks. quote 1: “These puberty-pausing medications are widely used in many different populations and safely so,” McNamara says. quote 2: “From an ethical and a legal perspective, this is a benign medication,” Giordano says. She is puzzled by the extra scrutiny these treatments receive, considering their benefits and limited risks. “There are no sound clinical, ethical or legal reasons for denying them to those in need,” she says. quote 3: Like any medication, GnRHas carry the potential for adverse effects. Now if you read one of the studies they link (https://pmc.ncbi.nlm.nih.gov/articles/PMC7497424/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7497424/). quote: "Arguments against the use of GnRHa that have been raised include possible long-term adverse effects on health, psychological, and sexual functioning (Laidlaw, Cretella, & Donovan, 2019; Richards, Maxwell, & McCune, 2019; Vrouenraets et al., 2015)." I really feel like they overstate the strength of their positions with the articles they cite. All of them show clear limitations of the results which clearly show we need more data.
- notahacker 2y ago
  I don't think Scientific American are exactly hiding that they hold a position on the issue. But I don't think that they've misrepresented that study, which is an observational study looking for evidence of whether there's any truth to those sorts of arguments (the citations appears to be two letters to the editor and an ethics paper...) which didn't find them, mainly because there weren't many dropouts to study.
Manuel_D 2y ago
It absolutely does offer that evidence. Blockers are indeed irreversible, they can lead to infertility and inability to orgasm depending on the length of time they're taken. Even shorter periods of puberty blockers will change height, muscle, and skeletal development. Evidence based medicine doesn't mean that we simply give people treatments unless they're proven to be harmful. It means we don't give treatments unless we know that the effects are positive. The UK is far from alone in pausing medicalization of gender dysphoric children. This is the case throughout pretty much all of the European continent at this point, prescription of puberty blockers and cross sex hormones is either banned or exclusively permitted as part of clinical trials - which means patients are explicitly told that this is experimental treatment, and the outcomes of patients needs to be tracked and published.