Transwomen are not Women - Part 14

[Roboramma]

"6.1 times as likely to die from non-natural causes as cis women'

Could that be largely from being assaulted/murdered?

As I said I suspect the differences in general are a combination of the health risks of transition and selection effects. The "non natural causes" difference is probably a selection effect, though it can also be potentially a sex effect: I'm pretty sure mortality rate from non-natural causes of males is significantly higher than females.* (See ETA)

Which gets a point here: it seems weird to compare trans women to cis women when the former are males from any meaningful medical and risk perspective. smartcookie's quote mentions "In comparison to men in the general Dutch population, the mortality risk was nearly double among transgender women" which is still pretty significant, but lower than the comparison to women. If there were no effect of being trans and no selection effects, we'd expect transwomen to be comparable to cis men, not to cis women. To be overly obvious: no trans women die in childbirth.

But of course, even that aspect of the comparison isn't the only issue. As an obvious example, they mention:

Most likely the starkest difference was the mortality risk from HIV, which was 47.6 times higher for transgender women in comparison to cis women.

Is it surprising that the rate of death from HIV is different between trans women and cis women? Again, I suspect that this a selection effect: ie. the population of people who transition also have a statistically higher incidence of higher risk sexual behavior.

For what it's worth, while I'm using "cis" here, I'm not a fan of it, but felt it was suitable to use the same words that the posted study uses

*ETA: I checked the study, it gives the mortality rate by "non-natural causes" for transwomen as being 2.7x higher than cismen, so still higher but by a significantly lower margin, as I suspected.

 

[theprestige]

Which gets a point here: it seems weird to compare trans women to cis women when the former are males from any meaningful medical and risk perspective.

In fact it seems so weird that I wonder if something is being lost in translation. What exactly is meant by "transgender women"? Is it transgender females - transmen? Or is it transgender males - transwomen?

Either way, it's silly for Gabeygoat to imagine that ticking the box is what triggers the health outcomes.

 

[Elaedith]

As expected, there are varied attempts underway to discredit the Cass Review. One of the current memes is that the review discarded 98% of the research supporting gender-affirming care for not being double-blinded (blinding being impossible for this type of treatment) and kept only two studies which had similar methodological flaws to those discarded because they supported a 'transphobic' conclusion.

This is, of course, complete nonsense. The source appears to be propaganda from a trans activist organisation. The reference to all but two studies being rejected appears to be either a complete fabrication, or a misrepresentation of this statement in a BMJ article pointing out that 'of more than 100 studies examining the role of puberty blockers and hormone treatment for gender transition only two were of passable quality'.

The review used established procedures to evaluate and rank all relevant studies (>100) for quality using the Ottawa-Newcastle Scale and found that only two were of high quality. However, those of moderate quality were also included in the final stage of analysis, and only those of low quality excluded. No studies were double-blinded, so obviously none were excluded for that reason. The review obviously did take the lack of high quality research into account when reaching the conclusions, which is why it concluded insufficient evidence to support the affirmation-only approach for minors.

Disturbingly but not surprisingly given the current state of academia, some academics have signed a letter condemning the review, and the letter repeats the demonstrably false statement regarding studies being excluded for lack of blinding. Interestingly, Andrew Wakefield has signed this letter.

 

[Abooga]

As expected, there are varied attempts underway to discredit the Cass Review. One of the current memes is that the review discarded 98% of the research supporting gender-affirming care for not being double-blinded (blinding being impossible for this type of treatment) and kept only two studies which had similar methodological flaws to those discarded because they supported a 'transphobic' conclusion.

This is, of course, complete nonsense. The source appears to be propaganda from a trans activist organisation. The reference to all but two studies being rejected appears to be either a complete fabrication, or a misrepresentation of this statement in a BMJ article pointing out that 'of more than 100 studies examining the role of puberty blockers and hormone treatment for gender transition only two were of passable quality'.

The review used established procedures to evaluate and rank all relevant studies (>100) for quality using the Ottawa-Newcastle Scale and found that only two were of high quality. However, those of moderate quality were also included in the final stage of analysis, and only those of low quality excluded. No studies were double-blinded, so obviously none were excluded for that reason. The review obviously did take the lack of high quality research into account when reaching the conclusions, which is why it concluded insufficient evidence to support the affirmation-only approach for minors.

Disturbingly but not surprisingly given the current state of academia, some academics have signed a letter condemning the review, and the letter repeats the demonstrably false statement regarding studies being excluded for lack of blinding. Interestingly, Andrew Wakefield has signed this letter.

Here´s a good collection of the attempts to discredit the Cass review that are floating in social media:

https://www.quackometer.net/blog/2024/04/breaking-down-cass-review-myths-and-misconceptions-what-you-need-to-know.html

 

[Matthew Best]

Here´s a good collection of the attempts to discredit the Cass review that are floating in social media:

https://www.quackometer.net/blog/2024/04/breaking-down-cass-review-myths-and-misconceptions-what-you-need-to-know.html

That was good - the comments on it are appalling.

 

[Lplus]

That was good - the comments on it are appalling.

There were three comments on the breakdown of the myths, all of them supportive - or did you mean the comments and comics that the breakdown was
deconstructing?

I see the first was from Billy the Red - a well known expert on gender dysphoria?

 

[Pixel42]

There were three comments on the breakdown of the myths, all of them supportive - or did you mean the comments and comics that the breakdown was
deconstructing?

I see the first was from Billy the Red - a well known expert on gender dysphoria?

When I clicked on the link earlier there was a disgustingly transphobic comment, which now thankfully appears to have been removed.

 

[Elaedith]

There were three comments on the breakdown of the myths, all of them supportive - or did you mean the comments and comics that the breakdown was
deconstructing?

I see the first was from Billy the Red - a well known expert on gender dysphoria?

He takes propaganda produced by trans activists groups and retweets it. He doesn't care if it's false as long as it looks 'progressive'. Lots of people replied pointing out that it's demonstrably untrue, and he responded by blocking them. After all, questioning the factual accuracy of a narrative produced by or on behalf of a marginalized and oppressed group is obviously transphobic. Anyway, facts are tools of oppression.

 

[Elaedith]

Here´s a good collection of the attempts to discredit the Cass review that are floating in social media:

https://www.quackometer.net/blog/2024/04/breaking-down-cass-review-myths-and-misconceptions-what-you-need-to-know.html

Yes, the other main one is saying that the Cass Review proposes banning transition until age 25, when what it says is that adolescents should not need to transition from child services to adult services until age 25 to ensure better continuity of care. You couldn't make this stuff up (well, they did).

 

[Hercules56]

Yes, the other main one is saying that the Cass Review proposes banning transition until age 25, when what it says is that adolescents should not need to transition from child services to adult services until age 25 to ensure better continuity of care. You couldn't make this stuff up (well, they did).

Children, should not be able to undergo transition surgery or medicinal therapy.

If adults want to do these things to themselves, fine. But not kids. They are too stupid, rebelious, angry, to make wise decisions for themselves.

 

[d4m10n]

The review used established procedures to evaluate and rank all relevant studies (>100) for quality using the Ottawa-Newcastle Scale and found that only two were of high quality. However, those of moderate quality were also included in the final stage of analysis, and only those of low quality excluded.

Out of curiosity, did any of the studies perform a head-to-head (RCT) comparison of the affirmative model (i.e. social transition plus endocrine pathway on demand over a certain age) vs. talking therapy alone or some other less interventionist approach? I've lamented once or twice about how the Tavistock was once in a perfect position to do this, as they transitioned from the latter to the former.

ETA: Just got to the top of page 50 and it looks like almost no RCTs were in play.

 

[Elaedith]

Out of curiosity, did any of the studies perform a head-to-head (RCT) comparison of the affirmative model (i.e. social transition plus endocrine pathway on demand over a certain age) vs. talking therapy alone or some other less interventionist approach? I've lamented once or twice about how the Tavistock was once in a perfect position to do this, as they transitioned from the latter to the former.

No, I don't think so. As far as I'm aware there has never been a study that used random assignment to medical transition versus an alternative approach. There are a few that compared medical transition versus psychotherapy without random assignment. These are often poor quality as they don't explain why some participants did not qualify for medical transition (which may have been due to having other serious uncontrolled mental health issues) or control statistically for differences at baseline. They don't tend to provide convincing evidence that medical transition is superior to psychotherapy, even with the statistical biases that would tend to favour transition.

I'm thinking of one that was criticised by Biggs but I can't find the article at the moment. It claimed that medical transition was superior to psychotherapy, but ignored that both groups showed statistically significant improvement, and that there was no significant difference between them at 18 months despite the comparison group having poorer mental health at baseline. To conceal the last point, they only reported the data up until 12 months, IIRC. I will check when I find the citation. Then there is that Tordoff one where those on puberty blockers didn't actually improve in mental health, but they still claimed they did because the control group's mental health scores got worse, but almost all the control group had actually stopped participating except for a handful with very poor mental health.

I need to go through the appendices to the systematic reviews the report used and look at how all the studies were rated. However, I heard that our friend Dr Turban's studies were all rated as poor.

 

[Elaedith]

Out of curiosity, did any of the studies perform a head-to-head (RCT) comparison of the affirmative model (i.e. social transition plus endocrine pathway on demand over a certain age) vs. talking therapy alone or some other less interventionist approach? I've lamented once or twice about how the Tavistock was once in a perfect position to do this, as they transitioned from the latter to the former.

ETA: Just got to the top of page 50 and it looks like almost no RCTs were in play.

Have you found any?

 

[d4m10n]

Not yet.

Top of page 50 says that "hardly any" exist, which would seemingly imply at least one does.

Figures 35 & 36 only list three types of observational studies (cohort, cross-sectional, & pre-post) all of which are significantly less useful than studies in which the researcher gets to assign different treatments to groups of patients thought to be alike enough to allow for generalization across a patient population with similar characteristics.

 

[d4m10n]

Went back to Google Scholar and found plenty of hits but none of them appear to be RCTs on gender dysphoric adolescent patients.

 

[Matthew Best]

There were three comments on the breakdown of the myths, all of them supportive - or did you mean the comments and comics that the breakdown was
deconstructing?

I see the first was from Billy the Red - a well known expert on gender dysphoria?

The appalling comments have now been deleted, I’m glad to say.


Sent from my iPhone using Tapatalk

 

[Elaedith]

Went back to Google Scholar and found plenty of hits but none of them appear to be RCTs on gender dysphoric adolescent patients.

I had a look through the systematic review of puberty blockade by researchers at York University used for the report. The study ratings are detailed in appendix 5.

The one study that was rated of high quality was:

Psychological Functioning in Transgender Adolescents Before and After Gender-Affirmative Care Compared With Cisgender General Population Peers


The study compared a sample of adolescents who identified as transgender and had been on puberty blockers and were about to start cross-sex hormones, with a sample referred to the gender clinic who had not started treatment, and a similar-aged comparison group that did not identify as transgender.

They found that the group who had received puberty suppression had better scores on factors such as anxiety/depression and peer relations compared to those who had not yet started. They also had similar scores to the non-trans comparison group while those who had not yet received blockers had poorer comparison scores.

I don't see how this design can control for any placebo/expectancy or non-specific treatment effects since there is no comparison with any other type of treatment.

They also state that 'It should be acknowledged that the care provided in the present study also involved the offering of appropriate mental health care.' but don't provide sufficient details to assess whether this was a confound. If the group who had received blockers had also received psychotherapy and the just-referred group had not, there is no way to attribute the differences to puberty blockade rather than psychotherapy.

In addition, although the authors mention some limitations including no long-term follow up, they don't appear to have considered that being just about to start cross-sex hormones may also have impacted mental health scores in the short term. Being on puberty blockers means lagging behind same-aged peers in development, which is likely to cause problems with peer relations. Anticipation that these issues are about to end with the development of secondary sexual characteristics is likely to produce a short-term improvement based on expectancy effects.

If that's a strongest study they have I infer there cannot be any RCT studies on puberty suppression.

BTW, since the authors of the highest-rated study are supportive of puberty suppression, that also directly contradicts the claim that Cass only included studies where the results support an 'anti-trans' agenda.

 

[Emily's Cat]

In my experience, progressive rights activists believe such things with the same sort of fervent devotion that Christians believe Jesus walked on water and Mormons believe he visited America. In fact I'd go so far as to say it's sort of a flex (in their own circles) to commit to the more outlandish versions of the dogma on offer. I say this as the sort of person who once bought an entire table at an ACLU fundraising banquet where we all rubbed elbows with the lawyers who trained the lawyers who drafted that complaint.

I am so very disappointed in ACLU. I used to support them a lot, but over the past several years, they've simply lost their minds completely. It's been slipping further and further away from their core principles for a while. I think the real tipping point for me was when ACLU took legal action to *block* an FOI request that was asking for prisons statistics that didn't even identify any individual, just aggregate stuff. Blocking an FOI request is completely antithetical to the purpose of ACLU historically.

Sincere belief in the doctrine that gender identity is the determinative facet of sex as a multifaceted phenomenon strikes me as a perfectly good reason to find that question difficult.



I believe we need to have an accurate characterization of the fundamental claims made by those who are sincerely advocating for the sorts of reforms mentioned upthread, e.g. gender identity sorting for restrooms and locker rooms in public schools.

What happens when I don't believe that most of the people making the arguments actually do sincerely believe what they're saying? What happens when I believe that only a very few people genuinely and sincerely believe that sex is irrelevant, mutable, or socially constructed... but that a large portion of people are dishonestly exploiting the loopholes that such beliefs would create if advanced into policy?


ETA: I liken this to some of the arguments made pre civil war in the US. Many people made the argument that black people weren't actually human, were some kind of subspecies. But if you read through what was written at the time, across many different perspectives, it becomes apparent that most people didn't actually for-realsies believe that black people weren't fully human - it was an argument that they used because it let them push a policy agenda that was exploitative in nature. It was an academic premise, not a sincerely held belief. I think this is very much the same - lots of people make the argument, because on conceptual grounds that premise allows them to push a policy that has obvious and blatant negative impacts on other people. They don't sincerely believe it, but it's a rhetorical bastion that they believe most people either aren't capable of arguing against, or are unwilling to risk taking on.

It's very, very much Emperor's New Clothes, except that in this case, the Emperor knows that they're naked and is incredibly pleased by their ability to cow all their subjects.

 

[Emily's Cat]

This is admittedly a recurring problem in these discussions, since all the key terms tend to be defined using all the other key terms. I vaguely recall going through all of this using a glossary of social justice some years ago, and being so frustrated that I didn't even bother to map it out.

That said, if we're going to be charitable in reading material like this, we have to choose interpretations which don't immediately lead to recursion or self-contradiction.

I don't think charitability is going to cut it though. A charitable reading *requires* that we accept the premise, and the premise itself is irrevocably flawed. If you cede any part of the false premise, you cannot combat the arguments that follow from that premise.

A charitable reading of a fundamentalist's dogma requires that we accept their premise that god created everything and that the bible is the literal word of god. But if you accept that premise, even for the sake of argument, it makes it impossible to combat their rhetoric - you've already ceded the fundamental disagreement.

 

[Emily's Cat]

Or to paraphrase René Descartes, "Cogito sum ergo sum" (I think I am, therefore I am)

This is a case where a more explicit translation is appropriate. In this case it lacks an object, so the "sum" is more appropriately translated as meaning "to exist". It ends up having a different contextual meaning than if one were to say, for example "I think I am tall, therefore I am tall". The presence of absence of an object for the verb makes a world of difference.