England Limits Youth Gender Medications, Part of Big Shift in Europe | Hacker News Reader

England Limits Youth Gender Medications, Part of Big Shift in Europe

nytimes.com

23 pointscempaka17 comments

It saddens me to see politicians deny patients life-saving treatments on the basis that it will score political points with their base. It’s unjust, immoral, and unscientific.

I feel for what the queer community - and in particular the trans community - in the UK has been put through in recent years. It shouldn’t have to be this way.

The evidence that pre-pubertal HRT (which can lead to lifelong impaired sexual function) and sex reassignment surgeries are "life saving" is extremely flimsy, which is part of why Europe is making this change.

The New York Times article calls it a "big shift". There's less than 100 young people taking puberty blockers in England:

https://www.cbc.ca/news/health/england-national-health-servi...

>There's less than 100 young people taking puberty blockers in England

<100 "prescribed by the NHS". FTA, there's a distinction made re. private prescription. I'm not in the UK so I can't say for sure if this means that there is an unknown number of individuals prescribed puberty blockers privately, plus the <100 via the NHS.

Note that this article focuses largely on puberty blockers. These are not the same as hormone replacement treatments or surgeries. The best way to describe puberty blockers is as a way to buy time to make decisions before the irreversible changes of puberty set in. They facilitate the deliberate, conscious decision-making everyone agrees on is important here.

The benefits of puberty blockers are well-documented and not hard to find. Here is a recent study of 20.000 trans folks aged 18-36 [1]. Those with access to puberty blockers had significantly better outcomes than their peers who didn’t. When factoring in the statistics about ideation, “life-saving” is undoubtably the right term to use.

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073269/

https://cass.independent-review.uk/home/publications/final-r...

"Given that the vast majority of young people started on puberty blockers proceed from puberty blockers to masculinising/ feminising hormones, there is no evidence that puberty blockers buy time to think, and some concern that they may change the trajectory of psychosexual and gender identity development."

This is the same report which is happy to make claims such as: “For many centuries transgender people have been predominantly trans females", and then leaves it as an exercise to the reader to divine how they arrived at that. The entire report is full of similar claims and does not seem to meet the bar we have for peer-reviewed science.

This is the same report cited by the linked article. It will take time to review the entire 300 page report, but as it stands it seems unlikely it will hold up to scrutiny over time.

Does it really matter if this small piece of background information is unsourced? A historical treatment of trans identity isn't the focus of the report.

Seems like rather an irrelevant criticism to be honest. I don't quite understand why you believe this to be a problem, or why you think this somehow undermines the rest of the work.

It did not take long for the claims the report makes to begin to unravel on closer analysis. The TransActual briefing on the Cass report [1] covers a lot of ground very succinctly, including the poor quality of supporting evidence for the claims the report makes on puberty blockers:

> The Cass Report reveals that it discarded huge amounts of medical evidence, both from the UK and across the world. Out of 102 studies into puberty blockers and hormones, only 2 were included by the Cass Review team.

> Further, the Report criticises the quality of evidence that WPATH (the international body which develops and monitors standards in trans healthcare worldwide) relies upon. No international evidence was considered good enough.

> Many, if not most, of these exclusions are on the basis of the studies not including 'blinding' and a control group, which would be not only an unethical approach to research but also practically impossible due to the clear impacts of either puberty blockers or hormones on the patients.

> In November 2022, WPATH rejected criticism around the lack of evidence around puberty blockers, stating that most of the evidence included the effects of other medication and interventions and that this was appropriate, and found that puberty blockers did have a beneficial effect for trans young people. This was ignored by the Review Team and by NHS England. For a long-established international medical standards body to simply be ignored is highly concerning.

[1]: https://transactual.org.uk/wp-content/uploads/TransActual-Br...

That briefing was written by people who clearly do not understand what they're reading.

For a start, this is factually incorrect:

Actually, a total of 60 studies were included: 26 in the review on puberty suppression and 34 in the review of masculinising/feminising hormone interventions. Only the lowest quality studies (43 of them) were excluded from the authors' synthesis.

You can confirm this by reading chapters 14 and 15 in the overall Review:

https://cass.independent-review.uk/wp-content/uploads/2024/0...

And the systematic reviews that those chapters reference (in paragraphs 14.19 and 15.15):

https://adc.bmj.com/content/early/2024/04/09/archdischild-20...

This briefing that attempts to critique the Review can't even get the basics right. It has unravelled only itself.

Puberty blockers are not simply a benign "buy time and let puberty start later if desired" solution. When started before the onset of puberty they can and have resulted in underdeveloped genitalia and inability to orgasm, which can even result in more limited options for sex reassignment surgery later down the line.

The study you've linked is of pretty poor quality -- in particular I don't understand how they could possibly have controlled for "level of family support for gender identity" when they had already selected the 2.5% of study subjects whose families provided them with puberty blockers in the first place.

The report is very clear that the claim of these being "life-saving treatments" is unsupported by evidence.

Subjecting children to such serious medical interventions should be evidence led, not ideologically driven.

Creating an impossible barrier by vague demands of evidence for when someone knows they don't want to be their assigned/apparent gender. I don't see how you can argue with someone after they've passed the hurdle of it not being a phase throw extensive counseling and parental interviews, but that they truly would be more comfortable living as another biological variant. It's unlikely to be strictly healthier long term because of the vast differences in X and Y chromosomes, epigenetic interactions, and drastic shifts in hormones, but that's better than someone killing themselves or suffering without the quality of life they could have if they weren't denied.

It is not a "vague demand" for evidence. Please see the Methodology section of the final report of the Cass Review for the detail of what is considered evidence-based medicine, both generally and within the context of the review: https://cass.independent-review.uk/wp-content/uploads/2024/0...

> but that's better than someone killing themselves or suffering without the quality of life they could have if they weren't denied.

Again, there isn't sufficient evidence to support this ideological viewpoint.

> Again, there isn't sufficient evidence to support this ideological viewpoint.

People dying and suffering is evidence enough.

Disingenuous analysis paralysis to impose an authoritarian worldview on others.

Nice try, but you're not fooling anyone.

Good luck to you.

Please do consider reading the report I linked. It really does go into considerable detail on the evidence-based rationale for its recommendations.

You may find insightful this quote from the report:

"Although some think the clinical approach should be based on a social justice model, the NHS works in an evidence-based way."

"Whilst navigating a way through the surrounding ‘culture war’, the Review has been acutely and increasingly aware of the need for evidence to support its thinking and ultimately the final recommendations made in this report."

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