Cass Report

[Planigale]

Is it not the case that there is a limit to how long puberty can be delayed before the window closes, as it were, and it does indeed never occur, so that the body essentially remains in a juvenile state? I got that impression from what I've read, but I may have misunderstood.

I am not aware of this; as said when I worked in endocrine clinics we wouldn't intervene unless puberty failed to occur naturally by 16.

 

[Emily's Cat]

This argument is predicated on puberty never occurring. Puberty occurs earlier now than it historically did. Delaying puberty to 16 means

still happens just later. You are creating a straw man argument, your case is based on puberty never occurring.

I think you're misunderstanding. The use of blockers for precocious puberty is to halt the pituitary process until the adrenal process kicks off. It brings them into alignment.

Delaying the pituitary process in someone whose adrenal has already triggered is not at all the same thing, and it has negative consequences. The two work together to govern pubertal development. If you only stop one, and let the other go on, things are out of sync. And since puberty is a time-bound process that only runs for a limited duration, halting the pituitary has permanent consequences.

By studying carefully the consequences in the few who opt after intensive psycho-social input for puberty delay, we will know if the consequences are as terrible as you claim. It is better that this happens in a well monitored system rather than the way it does in many parts of the world.

I already know the consequences. So do many doctors who deal with DSDs that involve the pituitary function not triggering properly. My godchild has Kallmann Syndrome. The problems associated with their pituitary failing to do its thing are well known and documented, and their endocrinologist was adamant that they needed to take exogenous progesterone and estradiol during the pubertal window to prevent those long-term issues from arising.

This isn't a mystery. We already know the risks of puberty not occurring as it's intended. Some advocates - including some doctors - have chosen to play dumb instead of being responsible.

I appreciate that your simplistic description of the physiology of puberty is intended for others but I don't need educating on endocrinology. We usually wouldn't treat delayed puberty in clinic until 16, just exclude conditions that might cause it. You state with certainty things that are not so certain, e.g. the association of delayed puberty with bone density. some studies show this some don't. this is one of the things that will be monitored, and could potentially be treated if it was an issue.

I state with certainty things that are certainly known.

It's why I specified that GnRH agonists are only safe to use during puberty if used for a very, very short time - generally on the order of a few months at most.

 

[Emily's Cat]

Is it not the case that there is a limit to how long puberty can be delayed before the window closes, as it were, and it does indeed never occur, so that the body essentially remains in a juvenile state? I got that impression from what I've read, but I may have misunderstood.

You've understood mostly correctly.

Some of the pituitary effects will resume when it's unshackled (hormone production in particular), but others won't. Most of the ones that won't resume are those that require both the pituitary and the adrenal processes to occur.

Bone density accretion and maturation of the reproductive organs absolutely requires both glands to be working together. If one or the other is interrupted for more than a short while, the effects are irreversible.

Many of the secondary sex characteristics will develop once blockers are removed, because they're not dependent on the adrenal gland. Some are more complicated. For example, the maturation of lactation glands in female breasts requires both the adrenal and the pituitary, but the deposition of fatty tissue in the breast area only needs the pituitary, and can be replicated in males via exogenous estrogen.

 

[Emily's Cat]

Fair question.

Since I am not participating in the service I don't know what the criteria are. My guess is that despite psychological intervention the child finds the progression to developing the secondary sex characteristics of the gender with which they do not identify so distressing that it is a threat to their health. In girls this might involve anorexia and extreme exercise to self delay puberty. A multi -disciplinary team might conclude that delaying puberty might allow time for psycho-social interventions to work.

I think you're assuming intensive psychosocial intervention is occurring in the first place.

My niece got a prescription for testosterone from a gender clinic after a 30 minute visit which did not address their pre-existing anxiety disorder, autism, and family history of bipolar disorder at all. At 16. Without parental involvement, because their state decided it's completely up to the child alone if they're over 13.

The guardrails you assume are in place - as every rational person would assume - aren't there. They've been removed.

 

[theprestige]

Fair question.

Since I am not participating in the service I don't know what the criteria are. My guess is that despite psychological intervention the child finds the progression to developing the secondary sex characteristics of the gender with which they do not identify so distressing that it is a threat to their health. In girls this might involve anorexia and extreme exercise to self delay puberty. A multi -disciplinary team might conclude that delaying puberty might allow time for psycho-social interventions to work.

I think you're assuming intensive psychosocial intervention is occurring in the first place.

My niece got a prescription for testosterone from a gender clinic after a 30 minute visit which did not address their pre-existing anxiety disorder, autism, and family history of bipolar disorder at all. At 16. Without parental involvement, because their state decided it's completely up to the child alone if they're over 13.

The guardrails you assume are in place - as every rational person would assume - aren't there. They've been removed.

I think at this point there's enough evidence that it's no longer rational for Planigale or anyone else to assume the guardrails are in place.

 

[Planigale]

I think at this point there's enough evidence that it's no longer rational for Planigale or anyone else to assume the guardrails are in place.

The system in the UK has significantly changed. I gave the figures. Less than 1% of those referred are proceeding to puberty blockers. I think this does mean 'guardrails' are in place. Or as I suspect that this is the last option in the protocol if alternative interventions have not been effective

 

[Emily's Cat]

The system in the UK has significantly changed. I gave the figures. Less than 1% of those referred are proceeding to puberty blockers. I think this does mean 'guardrails' are in place. Or as I suspect that this is the last option in the protocol if alternative interventions have not been effective

They are now... but that's a recent thing as a result of the Cass review, and still being argued against.

 

[Rolfe]

I can't make my mind up - we obviously shouldn't be using puberty blockers to treat kids who may be trans because we don't have the science to show that is a good treatment path so we need good science, which requires clinical trials, but is it ethical to even do such trials based on the slight evidence we have at the moment?

We ought to be carrying out well-designed animal experiments and requiring proper follow-up of the substantial number of people who were given these off-label drugs in the past, before even considering setting up a human trial, that's what.

 

[theprestige]

I can't make my mind up - we obviously shouldn't be using puberty blockers to treat kids who may be trans

There is no sane world where puberty blockers should appear in the same conversation as "kid may be trans".

There might be a sane world where "kid absolutely is trans and trans is a condition that needs permanent derangement of pubertal maturation as the least harmful treatment" is a sensical claim, but we're nowhere near living in that world.

The whole idea of puberty blockers in the context of transgender identity is poisonous. Stop promoting the nonsense.

 

[Rolfe]

That's fundamentally it. The entire concept is grotesque. Obscene.

But in a world where people are actually contemplating this obscenity, the very least that's required is to carry out rigorous preliminary research before even contemplating human trials.

 

[Emily's Cat]

We ought to be carrying out well-designed animal experiments and requiring proper follow-up of the substantial number of people who were given these off-label drugs in the past, before even considering setting up a human trial, that's what.

Something like the trial progression that is generally used for drug approvals? What a novel idea! It's so innovative, why don't we just do what we do with everything else instead of skipping all the in-between steps?

/s

 

[theprestige]

That's fundamentally it. The entire concept is grotesque. Obscene.

But in a world where people are actually contemplating this obscenity, the very least that's required is to carry out rigorous preliminary research before even contemplating human trials.

I'm hopeful that @Darat will return at some point to explain why he's even contemplating this, given what we know about the (lack of) science about the proposed "treatment", and given what we know about the complete lack of a reasoned explanation for why "trans" and "puberty blockers" even makes sense in the same conversation to begin with.

Even if we conduct studies, he still has no explanation how blocking puberty upholds trangender identities.

Does he mean transsexual identities? Blocking puberty leaves males more effeminate, making it easier to pretend to themselves and others that they're not male. Is that what he's talking about? We should do more research on puberty blockers, up to and including eventual human trials, to see if it's a healthy way to help males have an easier time pretending they're female?

Why is that even a goal? Do we seek out treatments that help paranoid schizophrenics maintain the delusion that gangstalking is real? Do we seek out treatments to help people with hypochondria or factitious disorder pretend that they really are ill for good reason?

And don't tell me transgender identity isn't a mental illness. If we're talking about using puberty blockers to help maintain a transsexual delusion, we're talking about a mental illness.

If a child is not being driven insane by being unable avoid the fact of their maleness, then there's no need to derail their natural maturation process. They can be transgender just fine, without being chemically maimed for life in the service of greater effeminacy.