Cass Report

[Rolfe]

I don't think the endocrinologists are misleading one another and the idea that young patients are being misled into believing they would receive all of the usual effects of natural puberty has yet to be supported with any evidence in this thread. When female detransitioners come forward saying they were promised working spermshooters, I'll take this alarmism much more seriously.

This is hopelessly naive. The endocrinologists have developed a God complex, convincing themselves that they can sculpt a male body into a female one and vice versa. I don't think their language is indicative of anything sane. And as far as what their patients are promised, it's not a question of explicit promises but of wishful thinking being allowed to continue without any application of reality to the dreaming.

Younger children are indeed left to assume that they can actually be turned into the opposite sex. By the time they're approaching puberty expectations are still unrealistic. Whistleblowing clinicians have reported on cases where girls have continued to believe they will be able to father children after transition.

Gross misuse of the word puberty is helping none of this.

 

[Emily's Cat]

I don't think the endocrinologists are misleading one another and the idea that young patients are being misled into believing they would receive all of the usual effects of natural puberty has yet to be supported with any evidence in this thread. When female detransitioners come forward saying they were promised working spermshooters, I'll take this alarmism much more seriously.

Look you can do whatever you want to do and take whatever position you want to take.

Personally, I'm getting really tired of the intentional humpty-dumptying of language. And in this context what we're talking about is medical professionals, researchers, and activists ALL trying to coercively *change* the meaning of a word so that it more closely conforms to the ideological view that activists are pushing.

Puberty is the developmental transition from juvenile to adult in mammals, particularly in humans. It is the process by which each sex becomes somatically capable of reproduction - even if not every single individual is fertile. The development of secondary sex characteristics and tertiary sex-linked traits happens ALONGSIDE puberty, but they are not actually puberty themselves.

Growing boobs isn't puberty. Puberty for females is the enlargement of the uterus and the onset of menarche. A female goes through puberty when *that* happens, even if they stay flat-chested the rest of their life.

Growing a beard isn't puberty. Puberty for males is the enlargement of the penis, the enlargement of the testicles and lengthening of the scrotal sac to move them further away from the body, and the production of sperm. A male goes through puberty when *that* happens, even if they remain hairless their entire life.

Playing linguistic games and trying to redefine puberty to mean growing boobs or a beard is an attempt to coerce a change in thought that is in direct opposition to observable reality in order to support a belief system. I'm not going to play that game, and I'm going to call it out as ◊◊◊◊◊◊◊◊ every time I see it.

 

[Emily's Cat]

No no no a thousand times no. I thought I already made this clear. Inducing fatty deposits in my breasts doesn't give me female secondary sex characteristics. It just gives me man boobs.

I agree with your sentiment. But in reference to d4m10n's ask, I think it's far preferable to "induced puberty". If you have a better suggestion I'm all ears.

 

[theprestige]

I agree with your sentiment. But in reference to d4m10n's ask, I think it's far preferable to "induced puberty". If you have a better suggestion I'm all ears.

"Deranged puberty".

"Cross-sex" puberty is a misnomer, calculated to imply a crossover to the opposite sex in some way. No such crossover is possible.

At this point in the debate, I think it's important to be very very clear about what these treatments actually do, versus what the insane trans ideologists want us to believe they do.

"We're going to initiate a cross-sex puberty" gives a naive child hope that the trans myths are true, and that a real boy can become a real girl in some way. Compare with, "we're going to derange your puberty, making your body a little more 'girly' in some inconsequential ways, at the cost of very consequential and permanent physical harm to you."

 

[Emily's Cat]

"Deranged puberty".

"Cross-sex" puberty is a misnomer, calculated to imply a crossover to the opposite sex in some way. No such crossover is possible.

At this point in the debate, I think it's important to be very very clear about what these treatments actually do, versus what the insane trans ideologists want us to believe they do.

"We're going to initiate a cross-sex puberty" gives a naive child hope that the trans myths are true, and that a real boy can become a real girl in some way. Compare with, "we're going to derange your puberty, making your body a little more 'girly' in some inconsequential ways, at the cost of very consequential and permanent physical harm to you."

I would love to have that as a required disclaimer.

 

[d4m10n]

Personally, I'm getting really tired of the intentional humpty-dumptying of language.

We all know what “Protocol Induction of Puberty” and “trans puberty” and “cross-sex puberty” all refer to the process which you describe as “induction of secondary sex characteristics” when used on minor patients who haven't yet passed a certain stage of natural maturation. Instead of word policing each other and trying to compel others to use our own preferred wording (which you recognize as an unwelcome distraction in the case of preferred pronouns) we could talk about more substantive medical or political questions.

And in this context what we're talking about is medical professionals, researchers, and activists ALL trying to coercively *change* the meaning of a word so that it more closely conforms to the ideological view that activists are pushing.

I don't recall seeing any examples of coercion here, and we can be pretty sure that puberty still means what it always has outside of the very narrow context of youth gender medicine, such as in this particular thread.

I'm going to call it out as ◊◊◊◊◊◊◊◊ every time I see it.

I'm going to keep using relevant terminology from practitioners of gender medicine as I see fit, unless persuaded otherwise by arguments that do not raise the specter of coercion where none exists. Don't get your hopes up, though.

 

[Planigale]

You're making quite a few cardinal mistakes here. Your first assumption is simply not the case, and is one of the fundamental problems with any trial of puberty blockers. It is not possible to identify the small subset of adolescents who want puberty blockers as juveniles, and who would still want to transition if they were allowed to go through puberty uninterrupted. There is no screening process proposed to identify such individuals, because no such screen exists.

It should not be controversial to accept that the best possible outcome for a gender-confused young person would be to become comfortable with their own unmutilated body and grow up into an adult who will not be a permanent medical/surgical patient and who is not at risk from any undesirable side-effects of having their puberty blocked and taking wrong-sex hormones. Around 80% of the children recruited into this study would have that outcome if they were not so recruited. However, it's known that the use of puberty blockers turns this 80% into pretty much 0%. Puberty blockers actually prevent the process that allows the young person to become comfortable with the body they actually have, and locks them into a trans identity and on to the path of wrong-sex hormones and mutilating surgery. Consider that first.

So this idea of simply using puberty blockers to delay puberty and then allow it to proceed later doesn't work. This was the original sales pitch, but it doesn't happen. Put these children on puberty blockers and the damage is done. They don't come off them and let normal puberty proceed. They are on the railway. What actually happens is that they become more anxious about puberty and more averse to it, also socially isolated as their peers all grow up around them and go through the physical and mental changes normal for their age, leaving the puberty-blocked frozen in children's bodies and childish minds. Then they grab the offer of wrong-sex hormones as the solution to all their problems.

That on its own should be an absolute block to this experiment. Before you even start, you know that you're preventing 80% of your subjects from having the best possible outcome. The supposed benefits, if they even exist, would only apply to the remaining 20%.

The proposed study has no intention of giving any of these children psychological therapy in the hope that they might decide to come off the blockers and let normal puberty progress. Everyone in the study has been promised blockers. Half will get them right away, and the other half will be forced to wait a year. That's all. The ones waiting a year aren't going to be persuaded they don't want them at all, they're simply going to be resentful and impatient and counting the weeks till they get to have them. It's simply a study to see whether a year's delay makes any difference.

I also wouldn't be too keen to talk to the people who had puberty blockers for precocious puberty, or the same drugs for breast cancer and other diseases, and tell them these drugs "aren't terrible". Many of them beg to differ.

You talk as if there is no serious down-side to this trial. Even leaving aside the incontrovertible fact that 80% of the participants will end up going through a transition they would have avoided if they had simply been left alone, there is strong evidence of significant adverse effects, from loss of adult bone density to loss of IQ points and cognitive deficiencies.

The idea that human experimentation, on children, should be given the green light in this context is terrifying. The limited animal studies are a huge red flag that this is far from a benign intervention, and it ought to be unthinkable that these drugs are given to physically healthy children without a comprehensive series of animal experiments to show that they are in fact acceptably safe. The other issue is the follow-up data on the thousands of young people who already went through the Tavistock. Again, it should be unthinkable that even more children should be fed into this meat-grinder without taking into account the outcomes of the thousands who went before.

"Some evidence" might be a good thing if we could be reasonably confident that children wouldn't be hurt in the attempt to acquire it. But we have no such confidence.

Planigale, you're remarkably keen to press ahead with this desperately flawed study, rather than step back and go through the normal preliminaries to human trials that would precede any human trial on anything else. Why so desperate for this, rather than proper animal studies and a detailed analysis of the outcomes of the existing patients - who were after all enrolled on a trial too?

But then, your persistent ignoring of the last half-dozen times I said the same things, constantly clinging to the fallacy that puberty blockers are harmless and reversible, and constantly rejecting the acquisition of basic safety data from animal tests, and the use of trans-activist language like "cis puberty" God help us, rather reveals where you're coming from on this.

The very best thing that can happen to these children is that they should be supported to go through the natural puberty that is their birthright, at the time their bodies initiate it. That they should be reassured that this natural process is not a disaster, on the contrary it is the process that will lead to their minds maturing and coming to terms with growing up. Why are you so opposed to this? Why do you frame this natural and beneficial process in such negative terms?

I am not arguing for a particular protocol. I am saying that research should be done. You say we can't identify the fraction of people who have transient gender dysmorphia from those who have severe and permanent gender dysmorphia. Cass made this very point, we have no screening test at present, that doesn't mean one can't be developed. that would be an area to research.

I thought I had been clear that my opinion is that the best option is to treat gender dysmorphia so that no one wants to transition. The best (psychological) intervention for treating gender dysmorphia is unclear, that is an area for research.

You stay as facts the consequences of puberty blockers, but where is the research to show this?

I did at least reference a review
https://www.engage.england.nhs.uk/c...scents-with-gender-dysphoria-october-2020.pdf

 

[Rolfe]

https://twitter.com/x/status/2021568746758787270

 

[Emily's Cat]

I am not arguing for a particular protocol. I am saying that research should be done. You say we can't identify the fraction of people who have transient gender dysmorphia from those who have severe and permanent gender dysmorphia. Cass made this very point, we have no screening test at present, that doesn't mean one can't be developed. that would be an area to research.

I thought I had been clear that my opinion is that the best option is to treat gender dysmorphia so that no one wants to transition. The best (psychological) intervention for treating gender dysmorphia is unclear, that is an area for research.

I am not a doctor or clinician.

Here's what I think would make sense in terms of research that could be done ethically:

• Run blinded tests of the drugs in question on animals in order to clearly and accurately identify the risks
  • Start with juvenile animals approaching the onset of transition to adult-hood
  • Track long term health outcomes, evaluate cognitive impacts, etc.
• Collect information on youth presenting as dysphoric now, including medical and potentially genetic screening (to capture data on the off chance that there's actually a genetic component for those who persist), current mental health disorders, history of abuse or sexual assault, contributing conditions like autism, etc. as well as social media usage, exposure to ideation narratives, and monitoring of overarching social influences
  • AFTER you have many years of research, do the deep statistical analysis to identify what *innate* characteristics are meaningfully correlated with persistence beyond puberty
  • Verify that the risk of false positives is negligible low for the correlated characteristics
  • Run the proposed test set of characteristics against a second, completely unrelated set of youth now presenting with dysphoria to evaluate model performance against a data set that is independent of the training set
  • *ONLY IF* the animal tests prove safe or minimal side effects and *IF* the test criteria for persistence performs very well with immaterial risk of false positives, *THEN* you can move into clinical trials on children

 

[Ziggurat]

We all know what “Protocol Induction of Puberty” and “trans puberty” and “cross-sex puberty” all refer to the process which you describe as “induction of secondary sex characteristics” when used on minor patients who haven't yet passed a certain stage of natural maturation.

Who is "we"? Do all patients and their parents know this? Do they also know that actual puberty involves more than this?

Instead of word policing each other and trying to compel others to use our own preferred wording (which you recognize as an unwelcome distraction in the case of preferred pronouns) we could talk about more substantive medical or political questions.

Informed consent is a pretty big substantive medical question. And the words one uses to describe procedures is rather central to the "informed" part of "informed consent". There's nothing equivalent between demanding accurate descriptions of medical procedures and demanding arguably inaccurate pronoun usage.

 

[d4m10n]

Do all patients and their parents know this?

Do parents of trans identified adolescent females know that their daughters won't grow a penis and testicles as a result of GAHT?

I mean, yeah, probably.

Informed consent is a pretty big substantive medical question.

As I wrote on the last page "...the idea that young patients are being misled into believing they would receive all of the usual effects of natural puberty has yet to be supported with any evidence in this thread."

 

[Ziggurat]

As I wrote on the last page "...the idea that young patients are being misled into believing they would receive all of the usual effects of natural puberty has yet to be supported with any evidence in this thread."

You seem oddly fixated on whether or not a very particular deception has occurred, rather than whether some kind of deception has occurred. I don't understand why you have adopted this as your standard. It seems like a way of avoiding the fact that deception has is fact occurred.

 

[d4m10n]

You seem oddly fixated on whether or not a very particular deception has occurred, rather than whether some kind of deception has occurred.

Who has claimed to be deceived by the way gender practitioners used the word "puberty" in their descriptions of GAHT for youths?

I'm open to the possibility that this has happened somewhere, sometime.

 

[Ziggurat]

Who has claimed to be deceived by the way gender practitioners used the word "puberty" in their descriptions of GAHT for youths?

Again, why are you trying to be this selective? Even if no one was deceived by that specific word alone, they were deceived. And changing how that word gets used makes the overall deception less likely, because it is in fact more truthful.

It's like you are looking for a loophole to try to make continued deception easier. I don't get your motivation here.

 

[Rolfe]

https://twitter.com/x/status/2030988533322682643

 

[d4m10n]

Again, why are you trying to be this selective?

Because the word police gave me a citation for using that particular word, just a page or two back.

And changing how that word gets used makes the overall deception less likely, because it is in fact more truthful.

If the gender medicalists scrupulously avoided phrases like “trans puberty” and “Protocol Induction of Puberty” with their adolescent patients and their guardians, they would just come up with even more appealing phrases instead, like "gender affirming maturation" or summat. You're going after labels rather than underlying intent, which is starting to become something of a theme.

 

[Ziggurat]

You're going after labels rather than underlying intent, which is starting to become something of a theme.

That's a very strange accusation to make.

 

[d4m10n]

This little rabbit hole opened up because of the accusation that calling GAHT for minors "trans puberty" was deceptive, which is to say that the label doesn't match what's in the tin. This is true in a literal sense, if we take puberty to mean all of the usual aspects of sexual maturation, but untrue in the sense that no one was actually fooled, at least so far as we know from the detrans lawsuits. Teen girls are able to comprehend that they will not literally develop their own wedding tackle and go on to impregnate their future wives.

 

[Ziggurat]

This little rabbit hole opened up because of the accusation that calling GAHT for minors "trans puberty" was deceptive

It is.

which is to say that the label doesn't match what's in the tin. This is true in a literal sense, if we take puberty to mean all of the usual aspects of sexual maturation, but untrue in the sense that no one was actually fooled

You haven't established that. You have instead tried to narrow your criteria to try to make establishing that impossible, again for reasons I do not understand. Your standard that "trans puberty" isn't fooling anyone unless they thought it would produce every single outcome of regular puberty doesn't actually make sense. If they thought that it would produce more of the outcomes of regular puberty than it actually does, then they were fooled. That's just basic logic. So why isn't that your standard? You seem to be engaged in motivated reasoning on this, and I can't figure out why.

Teen girls are able to comprehend that they will not literally develop their own wedding tackle and go on to impregnate their future wives.

Sure. But they may not be able to comprehend that they will not pass as males, that they will not actually feel like or behave like males, that they might never experience an orgasm, that they won't even fully mature, and that they will be cognitively stunted. Your bar for deception is nonsensical.

 

[Rolfe]

I am not arguing for a particular protocol. I am saying that research should be done. You say we can't identify the fraction of people who have transient gender dysmorphia from those who have severe and permanent gender dysmorphia. Cass made this very point, we have no screening test at present, that doesn't mean one can't be developed. that would be an area to research.

I thought I had been clear that my opinion is that the best option is to treat gender dysmorphia so that no one wants to transition. The best (psychological) intervention for treating gender dysmorphia is unclear, that is an area for research.

You stay as facts the consequences of puberty blockers, but where is the research to show this?

I did at least reference a review
https://www.engage.england.nhs.uk/c...scents-with-gender-dysphoria-october-2020.pdf

The issue is that we have a particular protocol proposed, and that protocol is deeply flawed. It proposes to use a couple of hundred children as experimental subjects to receive drugs where there is a large amount of anecdotal evidence pointing to probably severe harms. The children involved are physically healthy, and the justification for giving them these drugs is centered around relieving perceived mental distress. There will be no control group of children not given the drug, and the follow-up period of only two years is far too short to identify medical and psychological problems which are likely to arise as the patient ages into full adulthood, and as the initial happiness at having got the drug they wanted wears off.

I have no idea why you reject the obviously essential preliminary step of carrying out animal trials to establish whether or not these drugs can be regarded as acceptably safe. Many many promising treatments have had to be abandoned at this stage because animal trials showed unacceptable risks to patient health, and simply skipping this and going on to human trials isn't acceptable in any other context.

I have no idea why you reject the obviously essential step of analysing the outcome data from the thousands of children who were treated by the Tavistock before this was stopped. Much of the anecdotal evidence of harm comes from individuals who were part of this group, speaking up and detailing that harm. But it's "anecdotal" without a proper statistical follow-up of all the available data. The people who hold this data are flatly refusing to release it or do that analysis. Maybe think about that.

The review you cite really doesn't say anything helpful other than that the studies to date are inconclusive, usually due to poor design.

So if you want to argue for the development of a screening test to see if it's possible to identify that small percentage of distressed young people who will still want to transition once they have reached adulthood unmedicated, carry on. Have you any idea how long this might take?

Then you have to consider what you do with this small cohort once you have identified them. (I don't believe you'll ever be able to identify them, but we'll leave that for the purposes of argument.) Will they have happier adult lives if they're allowed to reach adulthood unmedicated, then undertake whatever transition protocol they choose, or if they have their puberty blocked and progress to cross-sex hormones without ever going through puberty? That needs a controlled trial.

The people promoting this are not interested in this approach. Their objective is to get more children on puberty blockers. And that seems to be about it. This is the protocol being argued against.

The zealots running this need to realise, first, that administering puberty blockers to an entire cohort of young people, when it's known that around 80% of that cohort would simply stop wanting to transition if they were allowed to go through puberty unhindered, is innately harmful. Second, they need to realise that any protocol which puts every subject on the treatment, leaving no group unmedicated but receiving psychological and psychiatric support, is worthless. Third, they need to realise that the harms from this treatment take time to emerge, and that two years is nowhere near long enough. But they're zealots, so they're not going to face any of this.