sodiummuffin
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User ID: 420
sodiummuffin
16d ago
That's why I suggest doing them in one of the countries that no longer recommends puberty-blockers - the choice would be between a 50% shot at blockers as part of the study or a ~0% shot as part of the general public. Theoretically some could go doctor-shopping internationally, but hopefully not enough to ruin the study. An unblinded RCT would still be a huge step up from the evidence we have now.
sodiummuffin
16d ago
Those sorts of concerns are why I emphasized the sheep RCT more despite it being in sheep. Unfortunately this is the state of the evidence regarding puberty blockers.
Though regarding your specific suggestion the IQ test was conducted as part of the puberty-blockers study, so they would already have some symptoms of precocious puberty. The study actually speculates that the early puberty was boosting performance relative to other children the same age and the drop was the result of stopping it (which is itself a concerning idea regarding using puberty blockers to stop puberty entirely):
The results on IQ measurements in children with precocious puberty showed elevated scores, with higher verbal than performance scores, and this was interpreted as a possible effect of sex steroids, especially on the left hemisphere (4, 30). The initial total IQ score in this group was not different from normal—comparable with the data of Xhrouet-Heinrichs et al. (4)—and a decrease of about 7 points was observed during the treatment period. Although significant, doubts exist about the clinical relevance of this decrease. One hypothesis for the decrease in verbal IQ scores is that withdrawal of exposure of the brain to sex steroids brings the child back into a more age-appropriate IQ range. The lower verbal scores in this group, which was in contrast to results in girls with central precocious puberty, could be explained by the adoption status of the children; as in other children from foreign backgrounds, it is known that verbal intelligence is lower than in children born in their own country. In primary school, mathematics, which is part of verbal IQ, was problematic in adopted children, especially in boys. The authors concluded that a deficient development of visual–spatial organization and, to a lesser extent, poorer concentration, may be due to the lower achievements in mathematics rather than to intelligence or fluency.
Who knows if this is meaningful at all though, it's speculative and sounds pretty dubious to me.
sodiummuffin
16d ago
What are the actual requirements for getting prescribed puberty blockers?
I think there's a lot of clinical discretion so it varies. I remember reading news articles about some prescribing them after a single appointment that you could try to look up, and here's an extreme example in Canada from a couple years back, where the "Gender Pathways Service" advises family doctors on prescribing them before a single appointment with a specialist:
“Given the distress that can be associated with Gender Dysphoria, we have also included information on puberty blockers that can be started prior to their initial appointment. We have included a Lupron Depot® Information sheet.”
Children’s Hospital, London, Ontario.
If they're willing to do that presumably they are also willing to hand them out readily themselves.
What are the probabilities of serious consequences from puberty blockers?
Copy-pasting the last comment I wrote regarding the state of the evidence for puberty blockers:
Puberty blockers both lock children onto the transgender pathway (making them largely equivalent to prescribing HRT in actual outcome) and have very serious and poorly-studied medical consequences of their own, including potential damage to brain development. In children the "watchful waiting" approach used to be standard, meaning the children were not given any "gender-affirming" medical or social intervention, just treatment for whatever other psychological issues they had. Did they continue to want to transition into adulthood or did their gender dysphoria desist on its own? Some studies on this were conducted, and according to this meta-study and this blog post the desistence rates they found ranged from 61% to 98%. If you just add the figures from the studies listed in the linked study it would be an overall desistence rate of 85%, or 80% for the studies listed in the linked blog post. By contrast 97% of children put on puberty blockers go on to take hormones (page 38). The lack of any randomized control study makes it difficult to be sure, but this seems indicative of a very strong "lock-in" effect.
The lock-in from social transition also seems very strong even for children not on puberty blockers (and may be a large part of the lock-in associated with puberty blockers), with this study finding the persistence rate of "binary transgender identity" to be 94% 5 years after social transition. The study mentions that persistence was less common for children that were transitioned before the age of 6, which significantly affects the results because they were 124 of the 317 children in their study, but still 90.3% compared to 96.4% for those 6 or older. 5 years isn't really long enough to know long-term desistence of course, but the explosion in rates is recent enough that it would be difficult to do much longer.
Meanwhile regarding the side-effects of puberty-blockers themselves there is very little high-quality evidence (e.g. randomized control trials in humans that track the things you want them to track), and essentially none for using them to avert puberty entirely rather than stop precocious-puberty for a few years. But this randomized study in sheep seems to indicate permanent damage to brain development:
The long-term spatial memory performance of GnRHa-Recovery rams remained reduced (P < 0.05, 1.5-fold slower) after discontinuation of GnRHa, compared to Controls. This result suggests that the time at which puberty normally occurs may represent a critical period of hippocampal plasticity. Perturbing normal hippocampal formation in this peripubertal period may also have long lasting effects on other brain areas and aspects of cognitive function.
In humans the best we have seems to be this study in which a 3-year course of puberty blockers in girls with precocious puberty is associated with a 7-point reduction in IQ from what they scored before beginning the puberty blockers. However without a randomized control trial and/or a longer-term followup it is difficult to know if this is meaningful, which is why I mentioned the sheep study first.
The NHS's independent review mentions a similar concern:
A further concern is that adolescent sex hormone surges may trigger the opening of a critical period for experience-dependent rewiring of neural circuits underlying executive function (i.e. maturation of the part of the brain concerned with planning, decision making and judgement). If this is the case, brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences. To date, there has been very limited research on the short-, medium- or longer-term impact of puberty blockers on neurocognitive development.
This all seems completely backwards and the opposite of the precautionary principle. A treatment as far-reaching and poorly-understood as preventing puberty should not be adopted as standard practice without conducting the research required to know if it is safe and effective. It should not be critics of the treatment looking through sheep studies and comparing desistence rates between different studies to find indications that it causes brain damage and treats gender dysphoria worse than doing nothing. It should be advocates having to do randomized control trials showing it actually improves outcomes relative to no treatment and that the damage to brain/bones/etc. is minor enough to be worth it. (In the U.S. it doesn't have to pass FDA approval because it's an off-label usage of drugs approved for precocious puberty. Unsurprisingly the trials conducted for that have little relevance to the way it is used for gender dysphoria, and frankly seem pretty questionable even for precocious puberty.) Instead it might be difficult or impossible to get ethics approval for such a study, since you're denying a now-standard treatment, particularly if you actually do it properly by advising your control group to not socially transition either. Since Sweden, Finland, Norway and the UK have in recent years advised against most or all usage of puberty blockers to treat gender dysphoria, hopefully someone in one of those countries will be able to conduct a proper randomized control trial?
I've been thinking the same thing. AI text seems so fundamentally uninteresting to me. The reasons I'm interested in humans talking is either to find out what people think or to learn actual information/insight about the rest of the world. AI doesn't do the former at all because there's nobody writing it so it doesn't let me know anyone's thoughts or feelings, and it's not reliable enough to be good at the latter. On rare occasion I've gotten use out of it as a search engine pointing me towards information I can verify myself, and I don't doubt various other uses as a tool, but beyond that? Back in the early days of GPT-2 through to GPT-4 I was interested in the samples posted by others, but that was because of what they indicated about the state of AI. Is it that some people enjoy the act of conversation itself even if they know there's nobody on the other end? I wonder which side is the majority, and by how much?
@Fruck compared it to parasociality but it's almost the opposite to me. For example I like reading other people discuss the same media I'm interested in. So do a lot of other people, that's presumably why people read Reddit or 4chan threads discussing media, read reviews for books they've already read, watch youtubers like RedLetterMedia, watch reaction-videos, etc. People want to know what other people thought, they want to empathize with their reactions to key moments, etc. AI-generated text has none of that appeal, if people are having parasocial relationships with it then their parasociality is completely different from anything I've felt. I guess the closest comparison is to parasocial feelings for fictional characters? If AI was capable of good fiction-writing I might be interested in reading it, the same way I can appreciate good-looking AI art, but currently it's not. Especially not when the character it's writing is "helpful AI assistant", hardly a font of interesting characterization or witty dialogue, yet a lot of people seem to find conversations with that character interesting.
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