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I'd like you guys to refrain from responding to this message (the one you are reading right now) unless you either are someone who holds the beliefs I am trying to engage with, or you can steelman how someone who holds those beliefs would respond to what I'm saying. Expressions of agreement are useless to me here. Thank you. (I have tried to get this discussion going on Twitter, but as one would expect, it hasn't worked.)
clears throat
So you, hypothetical person, believe that if a trans child has been on puberty blockers for the maximum of two years, then they should be allowed to switch over to HRT, even if they haven't reached the age of consent. So, for example, if a child starts blockers at age 12, then they should be able to switch over at age 14, even though the age of consent is no lower than 16 anywhere in the United States.
Why should the age of consent for HRT, the "real deal" of transitioning, be lower than the age of consent for sex? If you say that HRT is less harmful for children than sex with an adult, you need to be able to substantiate your claim.
Given that one is a medical treatment and the other a criminal offence, our prior should be that it is less harmful, and the burden of proof is on you to substantiate your claim.
But okay, I'll try. Google gives me the meta-analysis article Hormone Therapy, Mental Health, and Quality of Life Among Transgender People: A Systematic Review, which concludes:
It includes four studies on minors:
de Vries, 2011 reports positive outcomes, however, it only looks at puberty blockers, not cross-sex hormones
de Vries, 2014 looks at puberty blockers, cross-sex hormones and surgery, and reports positive outcomes
Achille, 2020 looks at puberty blockers and cross-sex hormones, and reports positive outcomes
López de Lara, 2020 looks at "cross hormonal therapy", which I assume is the same as cross-sex hormones, and reports positive outcomes
This post has a summary of the long-term effects of child sexual abuse, including "consensual" statutory rape, with an extensive list of references. It says, among other things:
I picked one of your studies at random (Achille) and it is garbage. They started with about 100 people and after treatment sent them questionnaires over a period of time. If someone stopped answering the questionnaire, they were dropped from the study. This left them with 50 people. Based on that, they found improvements in depression over time (though only significantly in MtF).
There are obvious problems with this study. First, those who stopped participating may not be random. It may be those who had a hard time stopped participating precisely because the intervention failed for them.
Second, the age group was quite large and was from 2013-2018. Attitudes were different back then and therefore the cohort getting the treatment back then is different from those getting treatment today. That is, is it possible that the people getting treatment back in the mid 2010s were more psychologically stable compared to trans people in general?
Third, they relied on surgery data; not what people actually did. We should be looking for actions not words.
In short, if that is among the best evidence for so called gender affirming care the evidence is very weak; especially since the study merely looked at “mental health” and ignored physical health.
Yes, the evidence is weak. That is precisely what the authors of the meta-analysis meant by:
If you look at the "Discussion" section, you will note that most of it is dedicated to pointing out problems with the studies under review. The article also notes that de Vries, 2014 has a "serious" risk of bias and the other three adolescent studies have a "moderate" risk of bias, and of the 20 studies they looked at, only three have a "low" risk. All of this means that further research is needed (it always is), but based on the evidence we have now I think it's perfectly reasonable to adopt a working hypothesis that puberty blockers and hormone therapy are beneficial.
Your points about self-selection among participants only imply that doctors should exercise care when choosing which treatments to administer to whom. Clearly some patients do benefit from hormone therapy, therefore the therapy should not be banned.
That’s not how this works. You don’t use a study that literally cannot prove anything (ie isn’t evidence of well anything) and say we should provide life altering drugs and surgeries to kids on those ground. This is an extraordinary intervention and therefore requires extraordinary evidence. Not dogshit level evidence that shouldn’t have been published.
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Sure, but what would the studies look like if NAMBLA had controlled the university and government grants systems since the 60s?
Even in the current environment the studies are so bad that the meta analysis is worthless. Junk in, junk out.
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A long time ago, we used to award internets for posts such as these. I don't know if I'm still qualified to issue an internet, but if I am, then you have won an internet, good sir.
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