UK Politics: Not even a Penny for a new Prime Minister

[TrackerNeil]

4 hours ago, mormont said:

One of the ironies of the Cass review is that a major theme is the 'toxicity' of the debate. And yet it has immediately been seized on by the most toxic side of that debate, with the aim of ramping up the toxicity even further.

This does not surprise me; there are always folks who mean harm, and they will always try to do harm. That's just a sad fact of life.

I'm curious, though, if you think the report has any merit.

[TrackerNeil]

13 hours ago, karaddin said:

Unless the argument is "puberty blockers are an unnecessary delay and we should proceed to actual hormone treatment" that just doesn't follow at all. 

The suggestion Hannah Barnes makes is that PBs are justified on the assertion that they buy time to think, but if nearly everyone who takes them winds up making the same decision in the end, are they really thinking? Is there something about PBs that makes one more inclined to proceed to hormones? I don't know of a definitive answer to that question.

[karaddin]

8 hours ago, TrackerNeil said:

The suggestion Hannah Barnes makes is that PBs are justified on the assertion that they buy time to think, but if nearly everyone who takes them winds up making the same decision in the end, are they really thinking? Is there something about PBs that makes one more inclined to proceed to hormones? I don't know of a definitive answer to that question.

It's entirely possible to continue with your original plan after taking time to think about it. And it's not just about time to think, it's about avoiding unwanted changes until they're allowed to take the hormones they need - hence my point, if the argument was that they should skip puberty blockers then that would actually follow. 

There's a very simple explanation for your last point - going on puberty blockers is not actually easy or minor, social transition on its own is already a highly confronting thing to do. Kids that wind up actually getting puberty blockers are mostly those that actually need them. It's evidence of the process working somehow being twisted into saying the opposite.

[TrackerNeil]

11 minutes ago, karaddin said:

There's a very simple explanation for your last point - going on puberty blockers is not actually easy or minor, social transition on its own is already a highly confronting thing to do. Kids that wind up actually getting puberty blockers are mostly those that actually need them. It's evidence of the process working somehow being twisted into saying the opposite.

The very reason the Cass Review was commissioned is that clinicians inside the GIDS center were saying that they did not know which kids needed PBs, and which didn't. They said that the clinic was handling too much demand, and that there was pressure to move these cases through. Jamie Reed said much the same about the clinic she worked for in Missouri.

My understanding is that north of 95% of the patients given PBs by GIDS eventually went on to hormones. Now, it could be that the GIDS clinicians were doing an incredible job of determining who really needed them, although Hilary Cass herself doesn't seem to think so. It's equally possible--and Hannah Barnes has certainly suggested--that something about being on PBs makes it more likely a person will want to go on to hormones. We really don't know.

Edited April 12 by TrackerNeil

[Spockydog]

I imagine quite a few Brexit voters are going to have to change their retirement plans. Boo fucking hoo.

 

[karaddin]

23 minutes ago, TrackerNeil said:

The very reason the Cass Review was commissioned is that clinicians inside the GIDS center were saying that they did not know which kids needed PBs, and which didn't. They said that the clinic was handling too much demand, and that there was pressure to move these cases through. Jamie Reed said much the same about the clinic she worked for in Missouri.

My understanding is that north of 95% of the patients given PBs by GIDS eventually went on to hormones. Now, it could be that the GIDS clinicians were doing an incredible job of determining who really needed them, although Hilary Cass herself doesn't seem to think so. It's equally possible--and Hannah Barnes has certainly suggested--that something about being on PBs makes it more likely a person will want to go on to hormones. We really don't know.

When you're point blank ignoring the most straight forward explanation for what you're seeing, and using that dismissal to conclude the medical professionals treating these kids are obviously doing a bad job, then it looks a lot like you've picked your conclusion before you've started and are trying to manufacture that conclusion.

[TrackerNeil]

1 hour ago, karaddin said:

When you're point blank ignoring the most straight forward explanation for what you're seeing, and using that dismissal to conclude the medical professionals treating these kids are obviously doing a bad job, then it looks a lot like you've picked your conclusion before you've started and are trying to manufacture that conclusion.

I don't know that I am ignoring the most straightforward explanation; I'm saying I don't agree with yours. And I am in good company; the Cass Review states unequivocally:

Quote

When the Review started, the evidence base, particularly in relation to the use of puberty blockers and masculinising/feminising hormones, had already been shown to be weak.

The report goes on:

Quote

Preliminary results from the early intervention study in 2015-2016 did not demonstrate benefit. The results of the study were not formally published until 2020, at which time it showed there was a lack of any positive measurable outcomes. Despite this, from 2014 puberty blockers moved from a research-only protocol to being available in routine clinical practice and were given to a broader group of patients who would not have met the inclusion criteria of the original protocol.

Quote

In addition to treating co-existing conditions, the focus on the use of puberty blockers for managing gender-related distress has overshadowed the possibility that other evidence-based treatments may be more effective. 

Quote

Moreover, given that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinising/ feminising hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development.

I think my concerns are in line with this report. Now, perhaps you think Hilary Cass picked her conclusion before she started and is trying to manufacture that conclusion, but I'd point out that she knows a heck of a lot more about what was going on at GIDS than you--and more than me, too. 

I imagine this report will be critiqued and evaluated, as it should be, but for now I feel pretty good that my concerns were shared by the expert who prepared this document. 

 

 

 

[karaddin]

I don't need to know anything about the specifics to see that logic doesn't follow. 

Lets say a process to do something requires significant hurdles to be overcome, followed by a cooling off period and then finally getting to do the thing you wanted to do when you started the process. If the vast majority of people who reach the cooling off period still want to go ahead with what they wanted before they started the process, then is it more likely that 

• The people that reach the cooling off period know what they want, the process works and they should now be allowed to carry on with getting what they want
• OR
• The cooling off period somehow perversely influenced people to...do what they already wanted to do

[The Anti-Targ]

13 hours ago, TrackerNeil said:

The suggestion Hannah Barnes makes is that PBs are justified on the assertion that they buy time to think, but if nearly everyone who takes them winds up making the same decision in the end, are they really thinking? Is there something about PBs that makes one more inclined to proceed to hormones? I don't know of a definitive answer to that question.

Given that, in the context of this discussion, every single person who goes onto PBs is someone who's self-identity leans pretty significantly towards transitioning it's is not unreasonable to see a close to 100% move from PBs to hormonal transition. A significant number of people choosing not to transition after taking PBs would tend to suggest a misdiagnosis, and possibly inappropriate prescription of PBs in the first place. So on balance I would say it seems like a good thing that almost everyone who takes PBs ends up going on to hormonal transition.

The best way to really know if PBs are causative of people choosing to transition is if you put a control group of pre-pubescent children not experiencing gender dysphoria on PBs and see what happens. There is simply no way any ethics board would approve giving any child PBs if they are not diagnosed as experiencing gender dysphoria. This is the problem with drugs like PBs, the sorts of scientific studies needed to determine if the drug therapy itself causes altered self-identity are almost all totally unethical (some smarter person might be able to come up with an ethical trial process). The question is whether it's more or less ethical to treat kids with gender dysphoria with PBs without a clear scientific answer about the direct effects of PBs. There are ways to come to a conclusion about that, which would be how many trans-people end up regretting the decision they made earlier in life, excluding for the reason that they have been made social and family pariah's because of their transition? If the number of people regretting their transition is very low, then that would suggest the effect of PBs is pretty benign.

[Heartofice]

3 hours ago, karaddin said:

I don't need to know anything about the specifics to see that logic doesn't follow. 

Lets say a process to do something requires significant hurdles to be overcome, followed by a cooling off period and then finally getting to do the thing you wanted to do when you started the process. If the vast majority of people who reach the cooling off period still want to go ahead with what they wanted before they started the process, then is it more likely that 

• The people that reach the cooling off period know what they want, the process works and they should now be allowed to carry on with getting what they want
• OR
• The cooling off period somehow perversely influenced people to...do what they already wanted to do

I think the dissonance here is coming from your assumption that these children do know their own minds, that these are simply 'trans kids' who need to put onto the right treatment that will help them. From that assumption its pretty easy to get to a place where you don't see any issues with the direct step from PB to Hormones, where that would just seem like a natural step.

However we need to remember the context in which this is happening.

Over the last decade or so we've seen an explosion in the number of children reporting to gender clinics for help. The nature of these children has changed to. There was an exponential rise in the number of children coming to GIDS from 2014.

An explosion’: what is behind the rise in girls questioning their gender identity?
 

Quote

 

"The figures alone do seem remarkable.

According to a study commissioned by NHS England, 10 years ago there were just under 250 referrals, most of them boys, to the Gender Identity Development Service (Gids), run by the Tavistock and Portman NHS foundation trust in London.

Last year, there were more than 5,000, which was twice the number in the previous year. And the largest group, about two-thirds, now consisted of “birth-registered females first presenting in adolescence with gender-related distress”, the report said."

 

It is not known why there has been such an enormous increase in these numbers in such a short amount of time. As Cass says:

Quote

"There is broad agreement that gender incongruence, like many other human characteristics, arises from a combination of biological, psychological, social and cultural factors."

But Cass also pours cold water on the idea that this is simply a matter of greater acceptance for trans identities in society (something many trans activists would debate anyway)
 

Quote

A common explanation put forward is that the increase in presentation is because of greater acceptance. While it certainly seems to be the case that there is much greater acceptance of trans identities, particularly among younger generations, which may account for some of the increase in numbers, the exponential change in referrals over a particularly short five-year timeframe is very much faster than would be expected for normal evolution of acceptance of a minority group. This also does not adequately explain the switch from birth-registered males to birth-registered females, which is unlike trans presentations in any prior historical period.

There is also the context of a huge rise in mental health issues reported by teenagers and children. Cass mentions that this is all very hard to disentagle and that peer issues are also most likely at play.

Then you put all of that context into a system that is unable to cope with the huge numbers, as well as a method of treating children that is based on affirming their trans identity rather than trying to understand whether it might be an expression of some other issue the child is experiencing. Cass reported how children were not treated as individuals but treated as a homogenous group that should be given the same treatment. Indeed the report mentions that the sheer act of looking for other causes to the child's complaints was seen as invalidating to their identity and so were avoided. 

So by the time children are being given puberty blockers they have already been put on a pathway to affirm their new identity without enough scrutiny as to whether there might be other causes at play. The giving of PB then just becomes another step on a one way process and another validating action to confirm what the child wants to hear. 

Then there is the whole issue that Cass is reporting on, that the evidence base for PBs themselves is incredibly weak, the benefits are not clear and there is potential long term effects on children's bodies and health. 

PBs are claimed to be 'time to think' for children, but the reality is very far from just thinking time. The reality is these children have already been place on an affirmative pathway lacking real scrutiny, that children with a range of conditions and past trauma have been given life altering treatments because there hasn't been the will or courage to challenge some of their assumptions, and due to an ideology that is built on a set of false precepts. 

Nobody is claiming that giving PBs to kids causing them to transition, the point is it is another affirmative action to push them in one direction, it is not about thinking space.
 

Edited April 12 by Heartofice

[karaddin]

If you consider being trans to be a pathology then the rise in it is alarming, if you view it as a natural form of the human condition then the internet and increased acceptance are more than enough to explain what is objectively still tiny numbers - even if we assumed 5000 was the "new" number of trans kids from a single year that's less than 1% of new births in 2022 (which was a lower number than the years these kids would have been born, so the reality is even lower). 

[Heartofice]

No I don’t consider that representative of children feeling more comfortable with trans identities, and the Cass review doesn’t consider it a good explanation either. I do think there are a range of other factors at play which has caused the rise. 
 

I can see why, if you think there is nothing interesting about those numbers, you might also not think there is anything interesting in anything the review said. 

Edited April 12 by Heartofice

[karaddin]

There's a difference between interesting and alarming. I don't think there's anything alarming in the increase. And if the review displays the same logic as was demonstrated about the puberty blockers I've got a lot less interest because honestly its so illogical its like the words mean something different.

[Heartofice]

You are entitled to your opinion. Having said that, I think that position has now become a bit of an outlier that people are willing to challenge and thanks to things like the Cass report we are now finally getting to a place where decisions will hopefully be made on evidence and it's helped wake people up to the reality of what has been happening over the past decade or so.

Edited April 12 by Heartofice

[DMC]

3 hours ago, Heartofice said:

The figures alone do seem remarkable.

According to a study commissioned by NHS England, 10 years ago there were just under 250 referrals, most of them boys, to the Gender Identity Development Service (Gids), run by the Tavistock and Portman NHS foundation trust in London.

Last year, there were more than 5,000, which was twice the number in the previous year.

I’m curious, what is the overall population?  As in, how many children/adolescents does NHS regularly see each year - or in other words, 250 or 5,000 out of how many?  I checked the link to try to find out myself but on a quick glance I couldn’t find anything.

[Heartofice]

1 minute ago, DMC said:

I’m curious, what is the overall population?  As in, how many children/adolescents does NHS regularly see each year - or in other words, 250 or 5,000 out of how many?  I checked the link to try to find out myself but on a quick glance I couldn’t find anything.

Well it's more than 5000, but I'm not sure why you think that is the question to ask here. 

[TrackerNeil]

7 hours ago, karaddin said:

I don't need to know anything about the specifics to see that logic doesn't follow. 

Lets say a process to do something requires significant hurdles to be overcome, followed by a cooling off period and then finally getting to do the thing you wanted to do when you started the process.

I'm not at all sure ths is the case in terms of receiving PBs, not at least from what I am reading. But that's not an issue related to the Cass report and I don't want to start thread drift.

[CORRECTION: By "cooling off" I incorrectly assumed a period of time before taking PBs.]

6 hours ago, The Anti-Targ said:

There are ways to come to a conclusion about that, which would be how many trans-people end up regretting the decision they made earlier in life, excluding for the reason that they have been made social and family pariah's because of their transition? If the number of people regretting their transition is very low, then that would suggest the effect of PBs is pretty benign.

I'm not sure anyone really knows just how many detransitioners exist, because these data just aren't collected, most of the time. Detransitioners often report that, when they decide to stop taking PBs or hormones, they don't notify the clinic; they just never go back. The clinic, naturally, isn't going to count that person as a detransitioner. You can look at some of the studies on the topic and see a good rate of loss-to-follow up; I recall one in which 72 patients were studied, thirty of whom simply dropped out of the study. Maybe none of those people were detransitioners, maybe all of them were--we just don't know. These studies also often don't span much time; regret, when it happens, might not occur until 5-10 years after treatment, and we'd never know. And, really, that's the thrust of the Cass Review. Cass herself writes:

Quote

 

This is an area of remarkably weak evidence

 

That makes me uncomfortable. I think it should make everyone uncomfortable.

In any case, I'm not here to argue about medical care for trans people in general; I'm interested in the Cass Review, which is available to all. I think folks have to read it and decide for themselves if this is something of concern.

Edited April 12 by TrackerNeil

[DMC]

4 minutes ago, Heartofice said:

Well it's more than 5000, but I'm not sure why you think that is the question to ask here. 

I’m literally just going off the quote you provided and is used in the article you linked.  And it’s a very simple question of scale.  Five thousand out of ten thousand is of course incredibly different than five thousand out of a million.  I’m honestly just trying to understand the data.

[Heartofice]

Just now, DMC said:

I’m literally just going off the quote you provided and is used in the article you linked.  And it’s a very simple question of scale.  Five thousand out of ten thousand is of course incredibly different than five thousand out of a million.  I’m honestly just trying to understand the data.

Sure, but why is it relevant?

Its the scale of change that is of relevance.

[DMC]

1 minute ago, Heartofice said:

Sure, but why is it relevant?

Its the scale of change that is of relevance.

The relative percentages should of course be relevant.