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Been reading an article about the child "transgender" story and something really caught my attention. The quote first:
So there I realized even though I am very far from woke, the propaganda has warped my understanding of the issue too. I was thinking what happens in such cases is some child suddenly starts very strongly feeling that they are the opposite gender, and then the system gets involved and "affirms" them in their delusion. But what is happening here is nothing of the sort. It's more like childish fascination with the unknown and unexplored and cool, which gets turned into much bigger thing that it should be by both the parents who are completely unable to provide the child the necessary structure ("just be what you are", wtf is that, that's not a kind of help the confused child lost in a confusing world needs) and the system which actively problematizes and medicalizes any case it can get the hold on.
The result is predictable - the system deploys the tactical nuke of "if you won't transition now, you child will surely kill himself and it'll be your fault", the parents fold like wet paper, child gets put on puberty blockers, develops severe mental problems, has to take five medications at the same time, becomes suicidal, the system reacts "see, we told you! if we didn't rescue them in time, them'd be dead already!" and refuses to budge. The parents finally see what a huge fuckup they did and start running around, screaming and writing articles.
The article worth a full read, but this was the part that struck me the most. It was how easy it was to get from a childish curiosity about "you can do that weird thing? really? let me try it on!" to being pulled into the machine and turned into a case and somebody whose life would forever be dependent on the medical system (and, of course, forever "oppressed"). I thought it's more like "X has a severe problem and it's hard to solve it and looks like the system doesn't always do the right thing the right way" but it's more of "X has been playing and waded too far into the woods, and the ideological ogres captured him and made his life into a problem with which he'll now have to live forever". Which is quite infuriating to me in its pure evilness.
At the end of the day, it seems like some of this is the old left’s anti-authority views- parents saying ‘no, that’s retarded, I can’t quite explain why but in five years you’ll be glad I didn’t let you go through with this’ isn’t a valid objection even when it is obviously correct.
I used to listen to a parenting podcast several years ago, and one of the hosts had a daughter -- age 10-11, maybe? -- who decided she was a boy. A good portion of the show became about this subject. The mother, a good California liberal with a fringe Hollywood career, was very honest about the heartbreak of reconciling with her sense of loss when one of her girls "became a boy" and chose a new name for herself, when the name the mother had chosen for her daughter had been a meaningful choice to the mother.... But the mother accepted this new identity, etc....
Sometime after the initial turbulence of this transition, in one episode the two hosts were talking about their kids' eating habits, and the mom with the transgender child was indignant that her kids often has the temerity to reject her planned meals and wanted either alternate meals or junk food for dinner. The gall of transgender son to think that they can dictate to their mother something as important as what they will eat for dinner! Where would a kid ever get such an idea?
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It's possible to explain, but an average parent probably would need a specialist support. Only there are no specialists that can support them now - there's woke transing disassembly line on one side, and I guess there's some conservative Christian support options which one probably wouldn't even consider if you aren't already a conservative Christian, and of which I know next to nothing, and so probably the average parent. And in modern Western world, where most people don't have the ingrained reflex of "the system is not your friend, it will hurt you and all you love" - this becomes an easy trap to fall into.
The conservative Christian support options exist, but they’ll start with ‘male and female he created them’ and then call in the TERF’s if they need secular arguments.
It’s probably worth noting that trans kids are specifically a liberal elite phenomenon, and conservative Christian authorities don’t particularly need to put together a set of secular arguments about it because that’s not how conservative Christian youth behave when they experiment with leaving. And honestly, the liberal elite parents are much less likely than average to call a pastor when they’re dealing with a situation- as any catholic priest could tell you, it’s not exactly uncommon for pastors to receive help requests from people who are not religious beyond going to whatever church is closest on Christmas and Easter.
That's my point - for a mildly liberal normie, who still doesn't want their kids life to be sacrificed on the altar of Trans, there's no support system. There are a lot of people like that, in fact majority of the people I know would likely qualify.
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It's worth pointing out that Blue Tribe is crowing about how this story has been debunked, because an unverified twitter account claiming to be the child in question is saying, despite all the facts in the article being correct, that they don't place the same emotional valence or cause and effect on it that the mother in the story does. They especially and annoyingly split hairs in that they admit the doctors said trans teens kill themselves without treatment, but the doctors never said they would specifically. See, totally no longer pressuring the parent! And it goes on and on with more of the same.
Of course my favorite, and typical, reaction is here at The Hill. Robby Soave, who seems to have made a career out of being insulted by irate leftist for plainly stating correct facts gets the typical reaction you'd expect when he brings up that children are being sterilized. I wish we could see the look Brie gives him when he brings that up, but the camera isn't on her. We can assume it was a helluva stink eye from how you can see her face turning before the camera turns away, and from how quickly Robby tries to ameliorate whatever offense she shows she took.
First, there are no verified accounts on Twitter any more. The legacy policy required that accounts be "authentic"; the new policy requires that accounts be "non-deceptive", but in no way actually checks that.
Second, they don't claim that "all the facts in the article [are] correct". From the article:
From the thread:
From the article:
From the thread:
The article doesn't make any effort to determine that the effect of counseling was, if the counselor recommended or encouraged medical intervention, just repeats Caroline's opinion. It leaves an unchallenged implication; the kid denying it is meaningful.
Is there a way to give informed consent here that isn't pressure under this rubric? Hey, if you don't get this shot, you're much more likely to die of COVID, but we're not pressuring you, right? Doctors are supposed to explain risks and benefits to the patient for any procedure; how can they provide information without "pressuring" someone?
By providing dry info. X% of people with your condition day within Y days, Z% of people who take this treatment have a A% chance of living to age B.
I guarantee you that the doctors did not do that in this case.
I'm not a doctor, and I'm certainly not an expert in communicating with people. But is that how doctors communicate in other circumstances? Does a doctor who notices that you smoke simply provide dry info and leave it at that? From what I can tell, standards around informed consent focus on whether or not information has been provided in a legible way to the patient or caregiver, not on the fastidious maintenance of strict neutrality.
I don't know how this was presented, and neither do you. But it's a stretch to say that it was presented meaningfully differently from how other medical procedures are offered, i.e., it reflects the standard of care in medicine generally. And if your issue is with the standards for informed consent, why tie it to a controversial set of procedures where the public, at least, absolutely does not agree about the risks and benefits?
In short, the dialogue looks like this to me:
It looks like either you're holding gender-nonconforming medical interventions to a uniquely high standard, or you're expressing a general issue you have with medical-ethical standards in an unnecessarily controversial manner.
I do know it wasn't presented in the way I described, because if you plug in the relevant numbers you will not get anything that can be seen as pressuring the parents into having their child take blockers.
You originally claimed it is not possible for a doctor to give information about a medicine, so the patient can give informed consent, without pressuring them into taking it. You can't criticize me for holding blockers to a higher standard, when all I did was give an example you asked for.
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Ah yes, the regulators don't let us to tell you your kid will kill himself if not put on puberty blockers, but since we can't tell you your kid will kill himself we can tell you other kids, who are totally not your kid, kill themselves all the time, but we're not talking about your kid, because the regulators would not allow us that. So, no pressure, totally your decision whether you want your kid to kill himself or not, we have no idea what'd happen, or at least we're not allowed to tell you what's happen, only that all other kids who are completely not your kid, did kill themselves, so you can choose anything you like. Also please sign here that we totally didn't pressure you about anything like telling you your kid would kill himself.
I think this proves too much.
Consider bariatric surgery on an obese patient. It's elective, and it has risks and benefits. It's shown to cut the risk of cardiovascular events like heart attacks and strokes in half. If your doctors tells you, look, we can't tell you that you will die of a heart attack, but people who don't get this surgery die of heart attacks all the time, so no pressure, it's your decision whether you want to have a heart attack, we have no idea if that'll happen, at least we can't tell you whether it'll happen or not because the regulators won't let us, so you can choose anything you like, and please sign here that we totally didn't pressure you about anything like telling you that you'd have a heart attack.
If you think that puberty blockers don't actually reduce the risk of suicide, then that's a real objection, a matter of fact, and someone is right and someone is wrong.
But in the world where puberty blockers do significantly reduce the risk of suicide in teenagers with gender dysphoria, what's the right thing to do? Not tell their parents about it? Informed consent is complicated, but communicating the risks and benefits of an elective procedure has to be part of it.
There's a difference between evaluating risk for oneself and being pressured to do allow procedure on a kid. People are usually much more vulnerable to manipulation via the kids than via their own fears (think of the children!).
I have no idea what the statistic is. We're not talking about averages and populations here. Bludgeoning parents with the suicide threat on the first sign of child being confused about his identity is not something that a honest specialist would do. If there was substantial risk of suicide, and the parents would ask about it, then the specialist should provide options to reduce it. Using it as a bludgeon is despicable.
Tell it when such risk is relevant. "Complicated" is not an universal excuse - consent may be complicated, not using underhanded tactics to force it - is not.
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The objection is that it is an experimental treatment, and that they're using the risk of suicide to push it, even though they have no evidence that it reduces the risk. There's place for experimental treatments, but you shouldn't scare people into trying them out.
Okay, that's fair! So, to be clear, this is a question of fact, and if the best estimate we currently have says that puberty blockers are, in particular circumstances, linked to a lower risk of suicide, then you wouldn't have an objection?
I'm aware of Turban et al. (2020) and Tordoff et al. (2022). Note that as of 2018, a literature review concluded that "the psychosocial effects of gender-affirming hormones in transgender youth have not yet been adequately assessed". So at that point, the right thing to tell patients and parents would be different. But it looks like you can reasonably say that puberty blockers are indicated in certain circumstances, and not using them carries an increased risk.
So as promised here's my links.
In 2019 the Swedish Agency for Health Technology Assessment and Assessment of Social Services published it's review of the literature on gender dysphoria in children and adolescents concluding there's little evidence (and no randomized controlled trials of children and adolescents). The review resulted in a change in policy on how blockers are administered, first at the Karolinska Hospital, and later nationally. The National Board of Health and Welfare concluded that the risks of puberty blockers currently outweigh the benefits, and they should only be administered under a research framework and in exceptional cases.
In 2020 UK's National Institute for Health and Care Excellence published a review of the literature on puberty blockers. The report concludes that to the extent there's evidence for good or bad impacts of blockers, the quality of the evidence is rated at "very low certainty". The review was used in the Cass Report resulting in the shutdown of Tavistock's gender dysphoria clinic.
In 2023 the Norwegian Healthcare Investigation Board published their report on Patient safety for children and young people with gender incongruence. They similarly conclude there's not enough evidence to routinely prescribe blockers to children with gender dysphoria, declared blockers experimental, and recommended that the Ministry of Health revise their national guidelines to restrict the administration of blockers.
There's been similar noises out of France and Belgium, but I've only heard about scientists raising an alarm, rather than an official report being published.
Thanks! I'd previously seen the difference between the Swedish model and WPATH recommendations, and kinda dead-ended there, because I'm not a researcher, just a layman trying to do my homework. (For example, I don't know how you could ethically do an RCT on puberty blockers in children and adolescents.)
I do notice that the NICE report excludes Turban et al. (the strongest evidence I'm aware of that puberty blockers reduce the risk of suicide) with the explanation "Intervention – data for GnRH analogues not reported separately from other interventions". (I don't understand why the criteria were set to exclude nearly every study.) On page 19 and following, it relies entirely on de Vries et al. (2011), which is a prospective study of seventy people, to conclude that "This study provides very low certainty evidence that treatment with GnRH analogues, before starting gender-affirming hormones, may reduce depression." So, in plain terms, it looks promising, but we don't have enough information to have a strong opinion.
It looks like the state of evidence is different now than it was in 2018. These questions are, generally speaking, answerable, and it looks like the best information we have indicates that puberty blockers reduce the risk of suicide in adolescents with gender dysphoria. Perhaps a good use of time would be to develop better diagnostic tools so that dysphoric adolescents who will likely not pursue transition aren't offered puberty blockers, and those who likely will, are.
Why is it ethical to RCT every other medication before it gets approval?
On that one in particular, I'd read some of the comments at the bottom of your link:
I don't think studies at "very low certainty" can be considered promising. From what I understand we're still in the midst of a replication crisis, so between that and publication bias, "positive finding at very low confidence" should probably default "it's probably just noise".
It might be answerable eventually, but the question is too complex to settle on the basis of the latest paper. Keep in mind we're not talking about the optimal way of setting a broken bone, or even about the best therapy for cancer, which has a lot more pitfalls. We're talking about psychiatry, a field that spent years prescribing SSRIs for depression only to go "oops, they might actually be no better than a placebo". With things like suicide in particular, we know there's a significant social contagion component, where even a silly Netflix show for teenagers can trigger a wave of suicides. So with ubiquitous messaging about trans healthcare saving lives, "would you rather have a happy daughter or a dead son?" etc, you don't even know if you're measuring the impact of the puberty blockers, or the impact of the messaging.
Finally, there being a positive signal in the literature that blockers may reduce suicide risk does not justify scaring the parents into allowing blockers for their kids. Far more confidence is needed to make such statements ethically.
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I'll gather my links tomorrow, but there are a more recent reviews from several European countries concluding that to the extent there is evidence for puberty blockers, it's quality is poor.
Aside from that, in the case of most other medications, you don't get to make such sweeping claims on the back of a few studies, and you have to go through blinded clinical trials before you can perscribe them for a given condition.
At best blockers could be considered experimental, and anyone trying to scare people into taking them is acting extremely unethically.
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