Children to no longer be prescribed puberty blockers, NHS England confirms | Hacker News Reader

Children to no longer be prescribed puberty blockers, NHS England confirms

news.sky.com

13 pointsdustedcodes19 comments

This is surprising to me. Is this really a political decision? My understanding is that puberty blockers are routinely used in cis kids with precocious puberty, and is well studied for that use.

It's an 'anti-woke' wedge issue, and it's an election year.

No, it’s a “do no harm to children” decision by the public healthcare service in the UK based on evidence and NHS England doesn’t stand in the election in case that wasn’t obvious.

Withholding medical care that has been demonstrated to result in positive mental health outcomes seems like the opposite of "do no harm to children" to me.

The research and evidence is extremely limited. Basically, we don't really know what long-term physical effects are. Given that all of this is pretty invasive, it would be surprising if there are zero effects.

This is not unusual; many medicines have side-effects, and we make cost/benefit estimates based on our knowledge of them. This is the "informed" part of "informed consent".

None of this is controversial as such. Some people are so worried that the "anti-woke warriors" will abuse any negative outcomes that it is now near-taboo, and apparently the activists prefer to uphold the unsubstantiated myth there are no side-effects. This is harmful not just to the people taking puberty blockers, but also to the public debate in general. Those same anti-woke warriors can now claim all sorts of things and you have very little to counter it with, because we just don't know. Also doesn't exactly instil trust in the movement either.

> The research and evidence is extremely limited.

Puberty blockers have been used for decades for a variety of other uses, but it seems like its most common use is to treat precocious puberty, which has a number of undesirable psychological side-effects.

What sticks out to me is that the medicine is not being withdrawn for anything other than gender dysphoria. It's a very bizarre line to draw for such a supposedly controversial medicine.

That's not too surprising since the Cass review just looks at transgender care, and not anything else. There's tons of medication that's approved for one condition but not the other. See: hydroxychloroquine and ivermectin.

It's about balancing benefits with downsides and risks, and those can vary from condition to condition, and from case to case. The other day I saw a story about puberty in a 2-year old, which is quite a different condition than gender dysphoria.

All I know is the "harmless and completely reversible with no effects" is not backed by evidence, as people have been saying for years. I'd say that from what I know, puberty blockers are probably the right choice for a large number of kids with gender dysphoria, but probably not all. I doubt that "it's the right choice for 95% of kids, but it may or may not cause long-term effects, we don't really know" would be accepted for any other medication.

If people had been actually researching this instead of obsessing over JK Rowling and generally being an asshole on twitter then everyone would be better off by now, trans kids most of all.

> That's not too surprising since the Cass review just looks at transgender care, and not anything else.

Which is a bizarre choice on its face, given that children with precocious puberty tend to be on these drugs for longer than those with gender dysphoria.

> If people had been actually researching this instead of obsessing over JK Rowling and generally being an asshole on twitter then everyone would be better off by now, trans kids most of all.

I believe that transgender people and their supporters are rightfully worried that this is the harbinger to significantly restricting or altogether banning gender-affirming care across the board, even for consenting and informed adults. If I thought I would lose access to medication that allowed me to not only function, but live a happier and more fulfilling life, as is the case in many US states, I'd be a bit cross as well.

Then again, I also don't feel like laying this problem at Twitter users' feet is very productive, considering how much of a trash fire the site is in its sum total no matter what conversation you're having.

The Cass Review looks at transgender care throughout the UK, and even that is taking many years. Not everything can look at every aspect of everything.

> Not everything can look at every aspect of everything.

If the question we are ultimately asking ourselves is if a drug that is used to block puberty in children is dangerous, the myopia of the cass review seems self-inflicted.

Precocious puberty is first and foremost a source of mental distress, just like gender dysphoria. The intended result of puberty blockers - blocking puberty - is the same in both cases.

You keep saying puberty blockers have no negative side effects because you think something that's been used in a certain context automatically equates to no side effects but that is simply not true. You might as well argue that radiation therapy is safe for everyone because it's been used on cancer patients for decades. This sort of narrow minded, unscientific and extremely ignorant argumentation is exactly what people are sick of and why this whole trans movement is becoming such a clown show. If we would be more honest about the real risks and trade offs then perhaps people wouldn't be so anti woke nowadays.

> You might as well argue that radiation therapy is safe for everyone because it's been used on cancer patients for decades.

Blocking puberty in children is not a novel use of puberty blocking drugs.

Blocking it entirely is indeed a novel use.

It is an procedure distinct from the mere delaying of precocious puberty.

You are misinformed. Puberty blockers are known to be safe to use for about a decade or so, and transgender children are not on them for nearly as long. It is used to buy time before either committing to adult gender-affirming care or (in the vast minority of cases) backing out.

In other words, it is very much in line with being cautious when it comes to children's healthcare, and any theoretical downside of taking the medicine needs to be weighed against the downside of abstaining from the only medication used to treat gender dysphoria in children.

Where is the evidence of safety and efficacy then? There's a reason why the NHS has scaled back usage just to clinical trials - this evidence is very much lacking.

It's pretty confusing.

Being a woman sucks, physiologically, compared to being a man. You have more heart attacks; you have brittle bones; you're weak.

But is that worth incurring if it means you don't kill yourself?

The reality is that our legacy biology is a clown show. The real and durable solution is to go posthuman. Until then, it's hacks upon hacks.

I read an interesting post from someone who claims to sit on an IRB here in the US.

In short, they were confused. The idea of suggesting more studies at a higher standards was a good thing. However, what puzzled them was that it was incredibly rare - at least in the US - to withhold existing treatments while those studies take place when not only have they been proven to have efficacy on a portion of the population, but the only treatment available. Pulling a treatment entirely seemed to be reserved only when there was absolutely no efficacy, such as in the case of a drug like Makena.

EDIT: You also bring up a good point - these drugs are being withheld for kids with gender dysphoria, but not for others. The more I read about the particulars of this ruling, the harder it is to avoid the idea that this is a political decision, and not one made with the kids well-being in mind.

But that's a different use to blocking puberty entirely for psychological reasons, which is what this change in policy is about.

This is good news. Pretty much all studies don’t do long term use and suggest further studies are required for the effects of long term use past the age of puberty. Experimenting on kids and lying to the public is not cool.

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