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Notes -
Are puberty blockers chemical castration?
A follow-up to the discussion with @netstack
This was originally a deep-chain reply, but after a few spergy, reddit-tier replies on my end, and @netstack's saintly curiosity, the conversation resulted in a decent-quality argument, that I'd like to get more eyes on and see I missed any obvious objections.
I did some extra digging as well. The wiki for Lupron links to the paper "Reforming (purportedly) Non-Punitive Responses to Sexual Offending", and while it's about triptorelin instead of Lupron, it's another GnRH. In any case a systematic review of the use of GnRH on sexual offenders (sci-hub) should hopefully settle the matter.
As a side note this paper makes me think the difference between GnRH's and DMPA's is that the former have (or promised to have) fewer side effects, not that they work on a fundamentally different principle (and while we're on the subject, let me just say I'm rather bemused at all the handwringing in all these papers about the side effects of these drugs on convicted sex offenders, when I compare them to the dismissal of any such concerns around giving the same drugs to children).
No, it just completely went over my head, lol.
This is a fun one. From what I understand chemical castration is meant to be reversible. This is what the wiki for chemical castration says right on the top, and I saw, but failed to bookmark, a paper that made that claim about DMPA's specifically, but that seems to be the general consensus on chemical castration:
So if irreversibility is a necessary condition for classifying something as chemical castration... than it seems that chemical castration does not meet the standard.
Now, I'm somewhat sympathetic to the "non-central" argument, you can argue that something that's reversible doesn't quite have that quality of having one's balls cut off that you'd expect from a term like "castration". It is also true you're going to have a hard time finding sources about the reversibility of puberty blockers, since dr. Cass' team looked, and all they can say is:
But when gender care providers themselves tell me that "puberty blockers are reversible (asterisk)", the asterisk being you can't stay on them too long, or that if you start them too early you're never going to have an orgasm, when celebrity cases like Jazz Jennings say they don't regret going on blockers, but the downside was "there wasn't enough tissue to work with when it came to the surgery" (and also don't know what an orgasm is), when the industry comes up with procedures like sigmoid vaginoplasties or zero depth vaginoplasties to either hack around or throw up their hands about the issue, can we say that there are good reasons to suspect some of the changes may be irreversible? What is even supposed to be the mechanism for reversibility? For a fully developed adult it's just a question of restoring testosterone levels and sperm counts, but for a child that never went through puberty we're basically hoping their body will catch up with development as if nothing ever happened.
Yeah, I know that as far as evidence goes, this doesn't rise to the standard of a proper well-designed study, but like I said in the other comment, the gender industry isn't particularly transparent about results they don't like. I understand wanting to remain agnostic on the reversibility question, but if you grant that these concerns are reasonable, it seems like puberty blockers are an at least as, and may possibly turn out to be more of, a central example of chemical castration, than chemical castration itself.
This is one of the topics that really broke my trust with the medical 'experts', along with the covid stuff.
There are some basic common sense things to know about medicine and if someone is going to make a claim contradicting it they need to have a lot of evidence and some damn good explanations.
The idea that halting a major development milestone would be harmless breaks every bit of common sense about child health. The idea that infection with a sickness does not grant any kind of immunity is also insane.
You have to be so so careful with this kind of thinking when it comes to medicine.
First, I'll say yeah everything related to Trans healthcare is fucked and if you put a doctor in a safe space you have a shockingly high likelihood that what they have to say is grossly off-narrative, but what is allowed to be said in public is totally different.
Okay, but-
Medicine is a mix of really obvious common sense things, sometimes with a clearly understood basis (a lot of cardiac physiology is just fluid going through tubes! Easy to model!) and things that are basically the most complicated thing we know about (ex: the brain).
It is not always clear when something is common sense and when it is not. Extremely unclear. To the point where professional medical researchers in a field will get this wrong, stake research and money and decades on something and totally not understand if it was common sense or not.
The classic manifestation of this is blithely labeled "clinical significance." Something can make sense in a lab or a Petri dish, or in a monitored study, but you unleash it on our population you find out it does jack shit.
This came up a lot during COVID - such and such trend medication would appear to have an impact on viral replication in a lab and then you'd give it to people and it would have no impact at all or reduce symptoms by one hour on average or something like that.
Sometimes we'd have a common sense explanation ("oh it's kinda like Tamiflu you just need to give it super early after exposure...so it's mostly useless") sometimes we don't.
Clinical medicine involves a lot of heuristics and experience to help figure out what is common sense and to guess ahead of research because research is slow and expensive and a lot of what we do is never researched because nobody can monetize it or research would be unethical.
It's a mess, but most physicians were just like "oh it's going to be like Tamilfu" from the word go and tuned out, while everyone else in the population didn't even know they had to think that way.
I'm getting a bit unfocused so to bring it back-
Common sense in child health frequently doesn't apply. The field is going to have findings that don't make sense to you (even if I don't agree this is one of them). Consider that for a long time "spanking is good for child development" was common sense. Then it wasn't. I'd bet money the research base for both conclusions is frustratingly unhelpful.
And for your other example-
Looking at the immune system as "oh you get sick and then you get immunity" is like looking at Moore's Law and then assuming it will go on forever. Are you going to be right most of the time? Sure, but does that tell you anything about the nuances of the system or for how long it will apply? No.
Plenty of infectious organisms don't trigger your immune system in a normal way or have weird interactions. For example: Herpesviruses. You have them forever! Does that count as immunity? Or not immunity? Shit I don't know.
TLDR: Common sense applies in medicine in a lot of places but sometimes not in what seems like an obvious place. This causes angst.
It's partly that they flipped all the standards of evidence on their head.
Interventions were considered safe until proven otherwise. Masking young kids in school, widespread adoption of a novel medical treatment (MRNA "vaccines"), puberty blockers, etc.
Covid is basically a flu/cold virus. All intuitions about such things turned out to basically be correct. And there was good evidence that was true in 2020 but they spent nearly four more years dragging it on. Unless you were part of a BLM protest, and then things were fine.
Biology can often be weird and unintuitive I get that. But when it gets weird is when you need more evidence and research, not a political wall of silence saying "you are a bad person if you don't believe us".
I literally cannot imagine a non life threatening scenario where hormone therapies would be allowed for kids. Hormones are definitely one of those systems that we don't understand very well. We know that getting it wrong can even cause life threatening conditions. We correctly vilify anyone giving out steroids to teen athletes, this seems just as dangerous and permanent.
With respect to Trans care-
A finicky part of this discussion is that it's really about two separate issues: 1. "Do we know if gender affirming care helps" 2. "How do we feel about it?"
Common sense is a poor guide because both sides think they have the common sense. Personally I will accept either outcome as to its usefulness, but I use the cheat of "we actively have zero idea because of poor research quality." However when most people talk about this they let question two bleed in, and that includes "what just makes the most sense?" The idea of gender identity problems is very poorly understood, including its natural history and pathophysiology (in large part because of willful blindness by advocates). It should be weird enough and unknown enough that "what makes sense" rarely applies.
With respect to COVID-
A huge problem here is the mixing of political and scientific questions. We (as in the field, but also me specifically on the old forum and with my family and so on) were upfront about lots of COVID stuff that turned out to be true. Most of it was consistent the whole time. Some of this falls into a bit of a medical talk vs regular people talk "it's just a bad flu" scares the shit out of us but most normies do not realize how bad the flu is. That's pretty normal communication problems in a fraught situation.
However when you talk about things like indefinite lock downs or nobody is allowed outside at parks those are political questions that were justified by appealing to science and having politicians (like Fauci) wear a doctor's hat. Additionally we have the problem of mandatory advocacy in the field (seriously it's a required part of medical school and residency training these days and guess which way it always leans) which resulted in a lot of doctors engaging in leftist nonsense hiding under science and medicine but it was leftist bullshit and should be treated as such - it isn't the fault of medicine or doctors its the fault of leftist institutional infiltration.
Medicine works just as well (or not well) as it always has outside the political topics. In the same way that your university or the IRS or whatever does.
The takeaway should not be "medicine is bad and we can't trust public health officials" it should be "medicine and public health officials are people and fall into the same politicking and fear and so on.
I mean, if we have zero idea then it's still a scandal anyway.
Yes!
100% going to be a situation where we think of modern gender affirming care as being similar to lobotomy (with the same ignoring the positive side of lobotomies) at some point in the future (could be soon could be later).
I directionally agree with most posters here on this topic.
BUT.
Common sense isn't the right tree to be barking up.
I would say the heuristic understanding common sense is applying the same standards used for non-political or non-controversial interventions to the interventions that are most controversial and politically entwined.
To be direct about it, that seems to be the literal meaning behind the phrase “common sense”; it is the sense making applied most commonly.
That seems to be the heuristic that cjet79 is applying so I’m confused as to why you’d disagree. Am I misunderstanding something?
My point is that the average person's understanding of common sense (or intuition) is generally a poor choice for application to medical topics. This is hurt even more by the fact that it actually works some of the time, so it is common for people to get the impression that common sense works well enough.
I do agree with some of cnet's conclusions, but I'm saying that he's right (when he is, by my reckoning) by essentially accident. While I don't think cjet does this, you see a lot of people overestimating on the topic of medicine with similar thinking.
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