3 ms·

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

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.
- notahacker 2y ago
  > Even shorter periods of puberty blockers will change height, muscle, and skeletal development. All of which are desired outcomes from the point of view of the patient at the time they request the puberty blockers, and for the duration of the time they keep taking them[1]. You don't conclude an otoplasty is harmful because the patient has less ear afterwards, but you might conclude the practice of otoplasty in minors was harmful if regret was a common outcome. And we know that the proportion of children who choose to cease gender-related treatment, like the proportion of children regretting elective otoplasties, is non-zero[2]. But what Cass absolutely didn't find was evidence to support opponents' presumption that the regret was somehow disproportionate. It just concluded the existing papers on the topic lacked the evidential qualities of some other areas of medical research. So sure, I'm going to agree there's a good case for raising the quality bar of the existing body of scientific research and doing so carefully, there absolutely is. But that's quite different from concluding that the evidence that is there points to frequency of unwanted side effects seldom found in treatments deemed safe and reversible. [1]or more specifically, the desired outcome is to prevent more rapid and less reversible physiological changes the patient expressly doesn't want to happen. [2]and in some respects elective otoplasty on minors is more complex: your ears don't rapidly and irreversibly grow if a clinic suggests putting body image aside and deferring the decision until adulthood, and the effects of the surgery are instant, rather than the result of a sustained process where the default is your ear reverting back to roughly the way it would have been was unless you commit to it for an extended period of time.

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.

notahacker 2y ago
> Even shorter periods of puberty blockers will change height, muscle, and skeletal development. All of which are desired outcomes from the point of view of the patient at the time they request the puberty blockers, and for the duration of the time they keep taking them[1]. You don't conclude an otoplasty is harmful because the patient has less ear afterwards, but you might conclude the practice of otoplasty in minors was harmful if regret was a common outcome. And we know that the proportion of children who choose to cease gender-related treatment, like the proportion of children regretting elective otoplasties, is non-zero[2]. But what Cass absolutely didn't find was evidence to support opponents' presumption that the regret was somehow disproportionate. It just concluded the existing papers on the topic lacked the evidential qualities of some other areas of medical research. So sure, I'm going to agree there's a good case for raising the quality bar of the existing body of scientific research and doing so carefully, there absolutely is. But that's quite different from concluding that the evidence that is there points to frequency of unwanted side effects seldom found in treatments deemed safe and reversible. [1]or more specifically, the desired outcome is to prevent more rapid and less reversible physiological changes the patient expressly doesn't want to happen. [2]and in some respects elective otoplasty on minors is more complex: your ears don't rapidly and irreversibly grow if a clinic suggests putting body image aside and deferring the decision until adulthood, and the effects of the surgery are instant, rather than the result of a sustained process where the default is your ear reverting back to roughly the way it would have been was unless you commit to it for an extended period of time.