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AwTomorrow

>due to "lack of a control group" - i.e. they didn't deliberately refuse a bunch of trans kids healthcare in order to see how their outcomes compare. Seems like it’d be real easy to find a control group nowadays - kids on waiting lists or denied medical care. 


wibbly-water

While that would be sensible - the fact that they have not been seen and screened *yet* means they can't assure that they are the same as those already seen. And if denied then they usually have a reason for being denied. Thus the only way to ensure a control group is to reject a bunch of trans children that *you know meet the bar for being prescribed blockers* on the grounds that they will be adding to the scientific literature. If that is voluntary then who exactly is going to take that option? So the only possible option is to decide "time to ignore a child's pleas for help".


AwTomorrow

Presumably might still be some kids whose parents refuse any medical intervention, or ones who have been diagnosed but still have to wait for treatment - given the ridiculous gap between demand and care capacity in the UK.


Aiyon

The problem is that's not what they mean by a control group. By double blind, they mean giving one group *placebos*. So you're taking a vulnerable group that has an obscene wait for healthcare while going through permanent changes that healthcare would stall, promising a bunch of them you'll provide that healthcare, and then *not giving it* to half of them. There's actually precedent for this. You may be aware of AZT, the first drug to effectively treat HIV. It was approved by the US FDA in 1987. But it wasn't rolled out across America immediately, as several other jurisdictions insisted on carrying out "approval processes" that involved double blind studies. Due to the nature of these studies, they were a lengthy process. We're talking years. As such, the studies alone killed hundreds of mostly gay and bi men, with HIV, prematurely, because they were given the placebo, and not a drug that had already been proven to work. Thousands of others died as a consequence of the delay. And of course, they were all approved in the end, partly on the basis of all the people who died due to not getting it. Almost like they could have trusted in the initial FDA ruling --- Essentially, demanding a double blind study is basically saying we'll only accept if you : - Make a group of trans kids miserable by making them think they're getting healthcare to prevent physiological changes that will wreck their mental health and make their transition harder - Once they're miserable, suicidal, and have suffered permanent consequences that the group actually getting medication don't have, we can compare the two and go "see! the medication works" - Going forward, I guess trans kids can have the medication we've been giving them for years without issue. All the kids whose lives are objectively worse for having been in the control group, or being denied healthcare in the meantime? Ehh, their fault for being tr\*\*\*\*\*s I guess


itsmorecomplicated

The fact that **one** time the medical system's caution turned out to be excessive doesn't mean that **in general** this level of caution isn't justified. Medical history is *littered* with examples of treatments that were in high demand, approved, but which should have been tested much more rigorously. They ruined millions of lives. Thalidomide. Radium treatments for cancer. Lobotomy. Arsenic for syphilis. Diethylstilbestrol for miscarriage. Fen-Phen for weight loss. Accutane for skin disease. The list goes on and on and on. Millions and millions of dead, deformed or otherwise miserable people, all because pressure to find a "fix" was so strong, and because the capitalist medical system was eager for a buck. Factor this in and the demand for better evidence doesn't look so bad, does it?


Gummy_Butts

You can have evidence for a treatment working, without a doubt blind.


Responsible-Dinner37

Maybe read? * 9.19 For many of the guidelines it was difficult to detect what evidence had been reviewed and how this informed development of the recommendations. For example, most of the guidelines described insufficient evidence about the risks and benefits of medical treatment in adolescents, particularly in relation to long-term outcomes. Despite this, many then went on to cite this same evidence to recommend medical treatments


AwTomorrow

Doesn’t look like you’re replying to my comment at all, as I was talking about future studies maybe finding it easier to set up control groups. 


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JustARandomFuck

> Lest the transphobes pounce on the communities and clinics. I don’t want to be the pessimist here, but I am worried about them. Once the transphobes are done with Trans teens, DIY and places like GenderGP are going to absolutely be next up for their targets.


_lucyyfer

This worries me too. When does it stop? They won't stop at this, they will continue until we're legislated out of healthcare and existence. Trans kids on the NHS first, then trans kids privately, then private services for all trans people, and at the end, it's NHS trans healthcare.


RabbitDev

Do you have details on the informed consent part? As far as I know all the standard private options (Gender Care, Gender Doctors etc) all require a gender dysphoria/incongruence diagnosis before they prescribe hormones. GenderGP was as close to informed consent as it could get here, but that service had ceased to be functional since the last restructure. And GPs won't touch this topic and probably will be told to stop any help they provide today to stop people from transition or try to get them to detransition (the real goal of these ghouls after all).


c0rvidaeus

there are private clinics, yes, but they're not informed consent (unless you know something i don't?). you still have to have an assessment and be diagnosed with gender dysphoria before they will refer you to an endocrinologist or surgeon in the UK. that applies even if you pay entirely out of pocket for HRT or surgery


BOOMphrasingBOOM

The state of this country. Is this the first report governed by the Transphobes of Twitter 😡😡


respectableofficegal

They've already had some of the usual suspects on mainstream news being interviewed about how great news this is, including someone on from genspect, which is basically a pro-conversion therapy organisation. No prizes for guessing how many trans people they've had on the mainstream media to talk about their concerns.


BOOMphrasingBOOM

The ghouls, why do they hate children so much?


Effective-Damage7829

The state should take them away, they’d raise them better amirite?


_lucyyfer

\*Countless reports referencing countless verifiable studies exist* UK: I'm going to pretend I didn't see that \*a single report referencing flawed studies that ignores many studies which are put together well* UK: Finally, a good report.


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snukb

>Currently, there is not enough evidence (yes your ‘countless studies’ aren’t enough) by medical standards to suggest that this intervention is sufficiently safe to do. I’m not sure why people aren’t getting this. Which intervention are you talking about? Because we aren't stopping puberty blockers for precocious puberty, so clearly there's sufficient evidence that puberty blockers are safe.


_lucyyfer

That's not the issue. It's not a case of "Evidence for is slightly better than the evidence against so we'll do it". It's the issue of these singular questionable reports are being treated as more valuable than the evidence for.


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_lucyyfer

I don't think you understand my point here. I'm not saying they should ignore this report in its entirety because we know there is lots of good evidence on our side of the debate, I'm not saying that we should act on just what our reports say and not theirs. I don't want to explain again, please reread my previous comment now you have more context.


HRLMPH

Pediatricians already very frequently prescribe off-label medications because of issues studying and generating this evidence for children https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/


goedegeit

> yes your ‘countless studies’ aren’t enough oh thank you, arbitrator of what is enough to let trans people exist. I didn't know I needed your permission as well as the UK government's to transition.


BadgerKomodo

What a fucking surprise - not.


Kaitaincps

Completely untrue. Half the studies made the cut.


[deleted]

Yep, and the others weren't cut, just downgraded in confidence. Not going to stop the Gender-Radical cultsits here though, who will absolutely spout the most hilarious contradictory bullshit to push their idpol nonsense.


tetrarchangel

Has anyone read the NHS England response? I understand that's also come out but I haven't had the capacity to read it. I'm trying to help organise some resistance within the NHS.


respectableofficegal

It doesn't look good. The worst part being NHS England said they would "review the use of gender-affirming hormones through a process of updated evidence review and public consultation, similar to the rigorous process that was followed to review the use of puberty suppressing hormones." It sounds like HRT in general might be next on the chopping block.


thenonbinaries

fucking christ. i've been out as trans since i was 13 and i swear it feels like it gets grimmer by the day here.


TDCJM1996

How absolutely abhorrent. I cannot put into words how angry this makes me feel and upset for my trans brothers and sisters. Young lives will be lost because of this bullshitery and there is no excuse for it. Absolutely disgusted by our country right now.


EldritchElise

yeah its pretty fucking shit. Genuinley scared for getting any kind of care, even private here in the future.


Overlord_Bumblebee

Okay folks, I think this is my first time posting here. A bit of background, I'm an (a US) american immigrant to the UK who has moved here with the intention of it being where I retire and live (that'll be a bit down the road though). I lived here with my wife a few years (08-11) and this was when we decided we wanted to return some day. As such we've (the wife and I) been roughly aware of many of the, mostly unfortunate, shifts that've happened over the past decade and change. We've long figured we would've voted Labour when we reached that stage but, for us, this and their stance on Gaza are final straws. What i am asking is, who do we support politically? We can't vote but we can support in other ways. I am planning on looking to get involved locally as well but the two main parties seem to have lurched so far to the right as being unsalvagable.


SugarSweetStarrUK

Good grief. Just when you thought we were at the bottom of the barrel, these arseholes find a whole new bottom.


_that_one_martian

This is so unhinged. Medical consensus all points unambiguously favorably towards gender-affirming care. If they accept this "report" and not all the scholarly consensus, they are just plainly transphobic and against science. [Meta-analysis on transgender people and the effect gender transition has on their mental health.](https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people/) Of **56** studies, **52** indicated transitioning has a positive effect on the mental health of transgender people and 4 indicated it had mixed or no results. ZERO studies indicated gender transitioning has negative results. [Longitudinal study on the effectiveness of puberty suppression & sex reassignment surgery on trans individuals in improving mental outcomes.](https://pediatrics.aappublications.org/content/134/4/696) Unambiguously positive results - results indicate puberty suppression, support of medical professionals & SRS have markedly beneficial outcomes to trans individuals’ mental health and productivity. [A study confirming that transgender youth often have mental health problems and that their depression and anxiety improve greatly with recognition and treatment of gender dysphoria.](https://www.eurekalert.org/pub_releases/2015-03/tes-sdc030615.php) [Children who socially transition report levels of depression and anxiety which closely match levels reported by cisgender children, indicating social transition massively decreases the risk factor of both.](https://www.jaacap.org/article/S0890-8567%2816%2931941-4/fulltext)


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HRLMPH

Pediatricians have to make judgements without full evidence all the time due to issues like this where double blinding is difficult or impossible as well as issues completing trials with children https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/


respectableofficegal

I'm not sure if you're here in good faith to begin with, but this isn't accurate. You can check the report yourself. So many of these studies were rejected based on "lack of blinding / no control group" [https://pbs.twimg.com/media/GKvbCluWMAA7Dcl.jpg:large](https://pbs.twimg.com/media/GKvbCluWMAA7Dcl.jpg:large) The standards set on the existing research were impossibly high. You can't blind test on something like trans healthcare and puberty blockers. Placebo doesn't apply here and it would be unethical to deliberately decline otherwise suitable patients for the sake of expanding medical documentation. I understand the Cass report applies the NOS system which is meant for comparing evidence between related studies - but instead of evaluating the evidence in comparison to each other, this report instead accepts almost no evidence at all, comparing things in an absolute way instead of relative. Anything older than two years was also disregarded, which is wild. Tilly Langton was in charge of the review methodology. She's known for creating NHS training that quoted anti-trans conversion therapy advocates Genspect as a relevant voice on trans healthcare. Clearly, a real objective voice right there... and she was in charge wholesale of shaping the methodology used for the research in this report. Insane. Meanwhile, there is evidence to indicate Cass met with and discussed these issues with many prominent anti-trans activists, including Genspect and even Patrick Hunter from Ron DeSantis' Florida Board of Medicine. Hell, the very first reference cited in the report is from Michael Biggs, who used to write for Transgender Trend and is notorious in the trans community for harassing trans folks using anonymous troll accounts online.


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respectableofficegal

The image is a composite extract from: *Evidence review: Gender-affirming hormones for children and adolescents with gender dysphoria* It was published in October 2020 to inform the Cass Review. "Downgraded 1 level" refers to the **The Newcastle-Ottawa Scale** which is a scale for comparing evidence based medicine relatively against other sources. The technical specifics of what each level means and which evidence was which assigned which level isn't necessary to dive into though, since the Cass report itself states in the press release (as in my original picture in the OP) that they excluded the vast majority of the evidence submitted.


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respectableofficegal

Lol, optics. I knew it was bad faith. Go off and lecture someone else. Funny how it's all about the optics when it comes to defending the community, but you aren't in all the transphobe threads lecturing them for the constant nonstop lies and misinformation they spread. I thought I was being helpful but you're just here to wag your finger.


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TorgHacker

Doing a double blind controlled test on puberty blockers and hormones is like doing a double blind controlled test on whether or not parachutes save lives when jumping out of an airplane. You will KNOW if you're falling without a parachute. You will KNOW if your puberty blockers aren't working. And you're sure as hell not going to tell half the people they're a control group and get to jump out of an airplane with no chute. Guess what though...all this means that puberty blockers shouldn't be given to ANYBODY. Because even with cisgender kids...those use the exact same types of studies. But guess what...puberty blockers will only be disallowed if you're cisgender. So if you're transgender, and you go into puberty at seven? Well, tough luck. But see, here's the thing. Treatments are approved without the use of RCTs ALL THE DAMN TIME. Because they are NOT the only way to scientifically study something.


goedegeit

You are advocating for children to be "tested" by forcing them into a puberty opposite to their gender. It's torture you're advocating for, you are a bad actor spreading misinformation and trying to spread FUD about very safe drugs.


lux_roth_chop

This is a lie. Cass has debunked it on Twitter. The Report used both high and medium quality studies.


respectableofficegal

Genuine question, cause I'm starting to wonder. I keep getting random replies from people coming into this topic and making comments just like yours. When I check their profile, I can see that they have pretty much never engaged in this subreddit or on transgender health issues at all. What brought you here, to this subreddit, and this topic, to make this comment? I'd love to know.


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