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Cass Report

I'm with those that are very concerned about the how of a human trial; it's easy to say glibly "oh we need to conduct human trials" and put an exception into the guidelines to cover that but what would such a trial entail? Can one ethically be carried out? I have serious doubts that it is possible.
 
Darat said:
I'm with those that are very concerned about the how of a human trial; it's easy to say glibly "oh we need to conduct human trials" and put an exception into the guidelines to cover that but what would such a trial entail? Can one ethically be carried out? I have serious doubts that it is possible.
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One view is in the absence of evidence about what is the best treatement the only ethical option is a trial. There are a variety of methodologies that can take into account patient preference. One suggested model is immediate versus deferred puberty blockers. The deferred group would be offered non-pharmacological intervention to address gender dysphoria and other issues e.g. depression, autism. One outcome might be how many offered intensive non-pharmacological support still opted for pharmacological therapy after e.g. three years.
 
Planigale said:
One view is in the absence of evidence about what is the best treatement the only ethical option is a trial. There are a variety of methodologies that can take into account patient preference. One suggested model is immediate versus deferred puberty blockers. The deferred group would be offered non-pharmacological intervention to address gender dysphoria and other issues e.g. depression, autism. One outcome might be how many offered intensive non-pharmacological support still opted for pharmacological therapy after e.g. three years.
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Blocking puberty in an otherwise-healthy child for three years is almost certainly irreversible and harmful. Assessing the degree of harm isn't really an ethical option.
 
Darat said:
I'm with those that are very concerned about the how of a human trial; it's easy to say glibly "oh we need to conduct human trials" and put an exception into the guidelines to cover that but what would such a trial entail? Can one ethically be carried out? I have serious doubts that it is possible.
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I agree. Before human trials are authorised a whole lot of preliminary data needs to be collected to ensure that there is a reasonable hope that the drug might be of clinical benefit, and that the thing appears to be acceptably safe. I very much doubt that these conditions can be met for a drug intended to block normal puberty.

The safety is doubful, both as regards physical safety (bone density and things like that) and mental safety (the loss of IQ points and the findings with regard to learning and anxiety in sheep). However, sometimes one has to weigh up the balance between risk and benefit. Maybe the benefits of the drug are such that the side-effects are considered to be acceptable?

What are the hoped-for benefits of puberty blockers when given to physically healthy children? Purely psychological. Risk a significant drop in IQ, problems with osteoporosis and probably infertility and lifelong anorgasmia, for what? The standard spiel has been to avoid the risk of suicide. There is precisely the square root of bugger-all evidence that suicide rates are lower in children who have had their puberty blocked.

Beyond that, it's cosmetic. Little Johnny will make a much prettier and more convincing girl if we stop such horrors as a baritone voice and a beard being visited on him.

I mean, what the actual :rule10?
 
Matthew Best said:
Woking isn't a city. It's been in the news twice this week - once because it's the home of McLaren, who won the Formula 1 constructors' championship, and the next time because it was the home of murdered girl Sara Sharif
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Don't make me tell you the Woking joke I know, and risk getting jumped on for off-topic.
 
OK, I can't resist. I Wagner's opera Die Walküre, the hero is going by a pseudonym when he enters. This pseudonym is "Wehwalt", which in German means something like lord of unhappiness or ruler of misery. In an early English translation this pseudonym was rendered as "Woe-King".* In act 2, when the villain is pursuing his former house-guest and calling him by the name he had given, he shouts "Woe-King! Woe-King!"

Of course, some wag in the audience interjected audibly "Next stop Basingstoke!"

*These days it's more likely to be "Woeful", and special bonus points to anyone who can spot the link between that and Neil Gaiman's "American Gods".
 
Reminds of the sad fact that many cities do not have an Vietnamese restaurant called, Pho King.
 
Rolfe said:
I don't think they should even be contemplating a clinical trial on human subjects before completing comprehensive animal testing that demonstrates safety. This simply would not happen in any other area of medicine.

The single animal study I am aware of demonstrated cognitive changes in young sheep which would be considered devastating to an adolescent human being. And that's before we even consider the physical effects on things like bone density.

The trans-activist response to this study was to mock the idea that sheep could be considered in any way comparable to human beings and to dismiss the expertise of the senior scientist involved because he is a veterinary surgeon.

Perhaps worse still, the evidence of bone density effects (in human patients) was concealed by the researchers involved by presenting the results as showing no change in bone density while the children were on treatment. Concealing the fact that at the time they were treated normal adolescents' bone density increases markedly. The puberty blockers had prevented this normal development.

In a sane world where proper animal trials were carried out and a proper retrospective analysis was undertaken of the results recorded in patients who already received the treatment, I don't believe this would ever get as far as a human trial.
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Slight aside... We've known for hundreds of years that neutering animals results in a retention of juvenile behaviors. Geldings are more docile than stallions, largely because they retain the behavioral profile of a foal. They attain generally adult size and proportions, but they don't develop adult behaviors. The same is true for domestic dogs and cats. Sterilized dogs retain a lot of puppy-like behaviors, sterilized cats retain kitten-like behaviors. Steers don't act like bulls. There's an entire set of cognitive behaviors that develop during sexual maturation in mammals. Why we would imagine that humans would be different is a mystery to me.

Also... in male cats, neutering reduces the development of adult male facial conformation. Toms actually look different from neutered males. Body shape, particularly abdominal, is different for spayed females and intact queens.
 
Elaedith said:
In regards to both cognitive and bone density effects, the key question with treating those who cease puberty blockers and go through natal puberty is whether they catch up with peers.
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Based on what little I know of Kallman Syndrome, bone density can only catch up if pubertal hormones are in place prior to the closure of growth plates. My goddaughter has Kallman, and their endocrinologist is one of a very few who specialize in that condition. The endocrinologist was adamant that they needed to start hormone therapy by age 14 at the absolute latest, because delaying beyond that risked permanent low density.

Whether or not cross-sex hormones would address that is something I don't know.
 
Emily's Cat said:
Slight aside... We've known for hundreds of years that neutering animals results in a retention of juvenile behaviors. Geldings are more docile than stallions, largely because they retain the behavioral profile of a foal. They attain generally adult size and proportions, but they don't develop adult behaviors. The same is true for domestic dogs and cats. Sterilized dogs retain a lot of puppy-like behaviors, sterilized cats retain kitten-like behaviors. Steers don't act like bulls. There's an entire set of cognitive behaviors that develop during sexual maturation in mammals. Why we would imagine that humans would be different is a mystery to me.

Also... in male cats, neutering reduces the development of adult male facial conformation. Toms actually look different from neutered males. Body shape, particularly abdominal, is different for spayed females and intact queens.
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Only if neutering is done before puberty. It's quite a debate in veterinary circles.
 
Planigale said:
People who didn't like the conclusions of the Cass report nitpick over methodology but provide no new facts or analysis.
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People who support the Cass review like to forget that she threw out all the scientifically conducted research and accepted the two studies that were by far the most flawed in methodology (so much so that they were Wakefield levels of bad). She later admitted to the Umbrella charity that she had no legitimate reason for doing so and that her conclusions had no scientific basis.

But hey, keep shouting that the Cass review wasn't written to a pre-ordained conclusion. You might even convince yourself some day.
 
Rolfe said:
Only if neutering is done before puberty. It's quite a debate in veterinary circles.
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I think it is worth remembering that what is proposed is not the same as castration as the puberty blockers are a temporising measure, with a view to move to 'pharmacological puberty' either with male hormones for FTM or female hormones for MTF. The alternative is going through natural puberty which may then mean transitioning is more challenging.

The questions one might ask are whether non-pharmacological approaches can address gender dysphoria, or whether it merely delays transitioning. Whether delaying / preventing natural cis-puberty to allow a trans-sex puberty, is better than allowing a cis puberty then trying to reverse it.

My personal view (having been one) is that many teen girls with gender dysphoria will grow out of it and need non-pharmacological support.
 
Gulliver Foyle said:
People who support the Cass review like to forget that she threw out all the scientifically conducted research and accepted the two studies that were by far the most flawed in methodology (so much so that they were Wakefield levels of bad).
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No she didn't. Cass did not make any decisions about what studies in include in the final synthesis; that was done by researchers from the Centre for Reviews and Dissemination at the University of York (a world-leading centre for systematic evidence reviews).
The UoY researchers accepted 60 out of the 103 studies evaluated, not two. The claim that only two were accepted is activist misinformation based on the fact that only two were rated high quality (moderate quality studies were also accepted).

Gulliver Foyle said:
She later admitted to the Umbrella charity that she had no legitimate reason for doing so and that her conclusions had no scientific basis
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No she didn't. That is utter nonsense.
Gulliver Foyle said:
But hey, keep shouting that the Cass review wasn't written to a pre-ordained conclusion. You might even convince yourself some day.
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You are repeating activist lies that can be demonstrated as objectively false with minimal effort, and already have been shown to be false. Why do you think it's ok to lie about a medical review of invasive procedures performed on children?
 
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Typically a distinction in the US too, a city is formally incorporated. Usually so they can have their own police and such.
 
Gulliver Foyle said:
People who support the Cass review like to forget that she threw out all the scientifically conducted research and accepted the two studies that were by far the most flawed in methodology (so much so that they were Wakefield levels of bad). She later admitted to the Umbrella charity that she had no legitimate reason for doing so and that her conclusions had no scientific basis.

But hey, keep shouting that the Cass review wasn't written to a pre-ordained conclusion. You might even convince yourself some day.
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You only had to read up to the third post in this thread to know that the above is false.
 
Rolfe said:
Only if neutering is done before puberty. It's quite a debate in veterinary circles.
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True. In the US, spaying and neutering of domestic pets is usually done within the first couple of months of life, well before puberty. I feel like it's partly done so early because it results in those pets retaining juvenile behavioral profiles... and we tend to think puppies and kittens are adorable.

I know for livestock, males are neutered prior to puberty intentionally so that they avoid developing adult male behaviors. Only a small number of horses, goats, sheep, cattle, etc. are allowed to become sexually mature males, and then they're largely kept as studs. Some exceptions for race horse where stallions outperform geldings AND can also be sold as studs when they're racing days are behind them.
 
Emily's Cat said:
True. In the US, spaying and neutering of domestic pets is usually done within the first couple of months of life, well before puberty. I feel like it's partly done so early because it results in those pets retaining juvenile behavioral profiles... and we tend to think puppies and kittens are adorable.

I know for livestock, males are neutered prior to puberty intentionally so that they avoid developing adult male behaviors. Only a small number of horses, goats, sheep, cattle, etc. are allowed to become sexually mature males, and then they're largely kept as studs. Some exceptions for race horse where stallions outperform geldings AND can also be sold as studs when they're racing days are behind them.
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I'm firmly in the "let them go through puberty" camp, and the more so after all that I've discovered in recent years. My late senior partner said tomcats should be left till three years old, although I fear I caved in with Caramel when he was two and Jori when he was 14 months. Both were very definitely post-pubertal though. (Rolfe was a three-year-old tomcat when I adopted him, so I didn't hang around. This late neutering was later held to explain why he swept the board at practically every non-pedigree cat show he rocked up for.)

I really don't see the point of the routine castration of dogs. The only dog I ever had was entire till he died and certainly when I was a student and a young vet that was normal. Most colts aren't gelded till after puberty around here either.
 
Rolfe said:
I'm firmly in the "let them go through puberty" camp, and the more so after all that I've discovered in recent years. My late senior partner said tomcats should be left till three years old, although I fear I caved in with Caramel when he was two and Jori when he was 14 months. Both were very definitely post-pubertal though. (Rolfe was a three-year-old tomcat when I adopted him, so I didn't hang around. This late neutering was later held to explain why he swept the board at practically every non-pedigree cat show he rocked up for.)

I really don't see the point of the routine castration of dogs. The only dog I ever had was entire till he died and certainly when I was a student and a young vet that was normal. Most colts aren't gelded till after puberty around here either.
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The argument made for routine castration of dogs round about these parts is to reduce the number of abandoned/surrendered puppies. Realistically though, I think it's done to keep dogs from humping everything in sight. I dunno. All my pets have come from shelters, and in the US shelters sterilize all animals that come through their doors as a policy. I never used to question it, it's just "how it was done". Now, after the last several years, I'm really reconsidering that outlook when it comes to pets.
 
Realistically, if you leave the females intact they will get pregnant somehow. Actual avoidance of puppies and kittens requires intervention on the female side. Let them have at least one oestrus cycle then have at it.

Mature tomcats are not fit to be inside a house, which is I believe traditionally the reason why pet cats are routinely referred to as "she", because only the females were kept as pets, and someone took on the responsibility of drowning the kittens. However, castrated tomcats make excellent pets (I'm typing round one now) and as they age they're much happier and healthier animals. Just put up with them long enough to let them go through puberty first.

Mature male dogs make perfectly cromulent pets most of the time. I believe castration of dogs should be reserved for cases where an actual behavioural problem exists which has a decent chance of being eliminated that way. Most dogs don't "hump everything in sight" if they're properly brought up and trained.
 
ahhell said:
Typically a distinction in the US too, a city is formally incorporated. Usually so they can have their own police and such.
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Right, but Woking is incorporated and much larger than most American cities.

This is still on me for not speaking British. :p
 
When I fill in US-generated forms asking for my address, I have to put West Linton down as my "city". It's a village with less than 800 houses in it. It is, however, the postal town.
 
Gulliver Foyle said:
People who support the Cass review like to forget that she threw out all the scientifically conducted research and accepted the two studies that were by far the most flawed in methodology (so much so that they were Wakefield levels of bad). She later admitted to the Umbrella charity that she had no legitimate reason for doing so and that her conclusions had no scientific basis.

But hey, keep shouting that the Cass review wasn't written to a pre-ordained conclusion. You might even convince yourself some day.
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See this is exactly the sort of thing this part of the the thread is interested in. What data backs up this opinion and where did you hear it? Genuine question, because I have not yet followed up a criticism that ended up being that strong. I only have so far seen 'this looks too much like they were just begging the question' type critiques, that hold water.
 
A petition has been started calling for 'An Independent Evaluation of the Cass Review on Child Gender Services'. It states that 'We believe that trans healthcare should be based on unbiased research that is peer reviewed.' I wonder if they are aware that all the systematic evidence reviews conducted for the Cass Research programme by the University of York were peer reviewed before publication? It would be funny if they reach 10,000 signatures and get a government response pointing this out.

One of the frequent misconceptions on social media involves misunderstanding what peer review (in the academic context) refers to. There are two main complaints: the Cass report was not peer reviewed; and the Cass report has failed peer review. The report itself was obviously not subject to academic peer review because it is a policy document, not an academic paper published in a scholarly journal. The second complaint is based on people thinking that other researchers criticising the report is peer review. Anyone is free to criticise a paper or report after publication. Obviously this is not 'peer review' that can be 'failed', or any academic could suppress research they disagree with just by criticising it, regardless of whether or not the criticisms have merit
 
Lithrael said:
See this is exactly the sort of thing this part of the the thread is interested in. What data backs up this opinion and where did you hear it? Genuine question, because I have not yet followed up a criticism that ended up being that strong. I only have so far seen 'this looks too much like they were just begging the question' type critiques, that hold water.
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I doubt you will get a response from the person you are addressing. However, I know that this misinformation comes mainly from Alejandro Caraballo and Erin Reed, along with other activists.

The idea that only two studies were accepted comes from the fact that only two studies were rated high quality (out of 103 studies). Misinformation was spread shortly after the final report was published, stating that over 100 studies were rejected, 98% were rejected, or only two were used (along with the misinformation that the reason for rejection was based on studies not being blinded RCTs), and this all went viral. The activists mentioned above were two of the major sources of misinformation. Of course none of this misinformation about methodology would have been circulated if activists liked the report's recommendations. As I said before, the recent NZ review downgraded almost all studies as low quality, as did reviews in other countries such as Sweden, but there is hardly a word about that because it hasn't yet been linked to major policy changes or cited in US litigation.

The strange claim about Cass backtracking on the report is harder to fathom, but I believe it originates from a blog post by Erin Reed concerning an interview Cass gave with the Kite Trust. The Kite Trust published an interview where they referred to Cass' answers in third person, showing they were not directly quoting Cass, and put some creative spin on the responses (basically telling people what they wanted to hear). This obviously conflicted with the original misinformation circulated about the review and both can't be true. Obviously Reed cannot admit that misinformation about the report was circulated, and can't say that the Kite Trust is fibbing, so the only way to resolve this was to pretend Cass had now backtracked on what was said in the report. This issue is addressed somewhat indirectly in the last point of the Cass final report FAQ.

The idea that the 'only two studies included' had worse methodology that the ones rejected follows logically from the accusation that Cass cherry-picked studies showing what she wanted. It is assumed therefore, that the two accepted must have conclusions that are negative towards GAC, and therefore they must have 'Wakefield bad methodology' because everybody knows science is on the side of GAC. In fact, the only study of puberty blockers that got a high quality rating was positive towards blockers. This was one of the Dutch studies that did have flaws but just scraped a high rating because the scale used to rate study quality was so lenient. Activists are actually saying that a key study on which the affirmative approach is based is 'Wakefield bad' because they need to believe that this study must not actually support the affirmative approach, otherwise the claim that studies were cherry-picked to suit the agenda of evil transphobes collapses. Of course they don't realise that the study they are dismissing is one that supports the affirmative approach, because they have not actually looked at any studies.
 
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The hypocrisy is crazy. Growing up, I "identified" as a daily victim of mob violence. Want to stop my suicide attempts? Let me have some steroids, even if I wouldn't get big enough to fight 5 on one attackers, at least i could probably run faster....but no, this very minor hormone change is somehow soooooo evil, but when you completely nuke someone's biology, that's a-ok
 
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