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Thank you for all of those that provided thoughtful responses. Anecdotally I had/have to make a decision with my daughter that isn't this, but is something where the medical community is not in full agreement and there are different options and it comes down to parent choice. From personal experience that really sucks. The reason is, if the professional experts are not sure how am I to be? Thank goodness me and my wife are on the same page because then what? I get why the professionals are giving the answers they are, but it would sure be much easier for them to just give me an answer. They even don't really want to give advice (probably because they don't want the responsibility of possibly being wrong, but I'm in the same boat with less training and expertise).
At any rate in these complicated decisions I think we as a society need to give a lot more grace to people. The ones that would pick to do it are not hero's or villain's, for the most part they are just people trying to do the best for their kids in a world where the answer is not clear and wading through the information and disinformation is near impossible. Same for the people who decide not to.
These decisions with time constraints and long term life changing consequences are hell to make and mega pressure. Unless you are some sort person who has 100% confidence in their assumptions.
People and doctors aren't being allowed to pick what is right for the patient. The political divide here is whether we should let parents and doctors make the best decision they can for the patient or whether the politicians should decide that for them. It's not over the specific choice that is made, it's who is allowed to make the choice. The Republican Party believe that they should make the choice for everyone.
On April 30 2025 23:03 Billyboy wrote: Thank you for all of those that provided thoughtful responses. Anecdotally I had/have to make a decision with my daughter that isn't this, but is something where the medical community is not in full agreement and there are different options and it comes down to parent choice. From personal experience that really sucks. The reason is, if the professional experts are not sure how am I to be? Thank goodness me and my wife are on the same page because then what? I get why the professionals are giving the answers they are, but it would sure be much easier for them to just give me an answer. They even don't really want to give advice (probably because they don't want the responsibility of possibly being wrong, but I'm in the same boat with less training and expertise).
At any rate in these complicated decisions I think we as a society need to give a lot more grace to people. The ones that would pick to do it are not hero's or villain's, for the most part they are just people trying to do the best for their kids in a world where the answer is not clear and wading through the information and disinformation is near impossible. Same for the people who decide not to.
These decisions with time constraints and long term life changing consequences are hell to make and mega pressure. Unless you are some sort person who has 100% confidence in their assumptions.
Add to that that the quality of care and followup is dependent on what your region is because not everyone has resources to spare. If you can't really move back and forth >100km to find a doctor that can do the best thing for you, you need to settle with locals and hope they're informed/practiced enough to give adequate care. Medicine is a weird profession honestly.
On April 30 2025 23:08 KwarK wrote: People and doctors aren't being allowed to pick what is right for the patient. The political divide here is whether we should let parents and doctors make the best decision they can for the patient or whether the politicians should decide that for them. It's not over the specific choice that is made, it's who is allowed to make the choice. The Republican Party believe that they should make the choice for everyone.
First of all your whole idea of right and wrong hormones makes no sense. Biologically the "right" hormone is the ones DNA code for. Psychologically it's the one that affirms the gender the person feels the belong to.
Puberty is a growth phase where an incredibly complex biological system are making some major changes and bringing interconnected biological, mental and psychological systems online. It's not as easy as one does male one does female. On top of that since we are a social animal all this is supposed to happen alongside finding our place in society as we transition from children to adults.
Fucking with this system in any way (as we are already doing with social media, food, medications etc) is not risk free. Not even if you delay it. The only reason it kind of works is that your body builds life support and basic function first so it's done. Hormones are ultra potent in effecting change. Try fucking around with other hormones in a younger development stage and you have a dead kid. Hell, try changing some hormones in an adult and see what happens.
Also don't let doctors decide in general. It's a terrible idea. You are always going to find a doctor willing to do whatever even if 99% of the field thinks it's a bad idea. With low evidence it should be restricted to research only so the patients end up in the correct place.
Also if this was a new heart medication the amount of required pre clinical studies required is very high. I just assume some of that is already done but as just a few examples you would like high quality cohort studies on gender dysmorphia and it's effect over long time (10-15 years) in untreated groups with a matched control cohort, studies on the effects of delayed puberty and of course the effect of adding hormones on long term health. Before you have solid evidence of that you can't do risk assessment vs benefit and you can't properly evaluate the effect of treatment.
So if the evidence is weak shore that up before even considering letting doctors start up treatments outside research.
So my initial gut feeling is that people feeling born in the wrong body feel this way before puberty, but is enhanced when they enter puberty because of the secondary sexual characteristics. Persisting feelings/strong ideas originating in children don't just easily reside when having gone through puberty.
On April 30 2025 23:08 KwarK wrote: People and doctors aren't being allowed to pick what is right for the patient. The political divide here is whether we should let parents and doctors make the best decision they can for the patient or whether the politicians should decide that for them. It's not over the specific choice that is made, it's who is allowed to make the choice. The Republican Party believe that they should make the choice for everyone.
First of all your whole idea of right and wrong hormones makes no sense. Biologically the "right" hormone is the ones DNA code for. Psychologically it's the one that affirms the gender the person feels the belong to.
Puberty is a growth phase where an incredibly complex biological system are making some major changes and bringing interconnected biological, mental and psychological systems online. It's not as easy as one does male one does female. On top of that since we are a social animal all this is supposed to happen alongside finding our place in society as we transition from children to adults.
Fucking with this system in any way (as we are already doing with social media, food, medications etc) is not risk free. Not even if you delay it. The only reason it kind of works is that your body builds life support and basic function first so it's done. Hormones are ultra potent in effecting change. Try fucking around with other hormones in a younger development stage and you have a dead kid. Hell, try changing some hormones in an adult and see what happens.
Also don't let doctors decide in general. It's a terrible idea. You are always going to find a doctor willing to do whatever even if 99% of the field thinks it's a bad idea. With low evidence it should be restricted to research only so the patients end up in the correct place.
Also if this was a new heart medication the amount of required pre clinical studies required is very high. I just assume some of that is already done but as just a few examples you would like high quality cohort studies on gender dysmorphia and it's effect over long time (10-15 years) in untreated groups with a matched control cohort, studies on the effects of delayed puberty and of course the effect of adding hormones on long term health. Before you have solid evidence of that you can't do risk assessment vs benefit and you can't properly evaluate the effect of treatment.
So if the evidence is weak shore that up before even considering letting doctors start up treatments outside research.
Puberty blockers aren't a new medicine, they're an old and tested treatment for precocious puberty, a medical condition when the DNA, which doesn't always know what it is doing, sends a child into puberty way too early. The body is not infallible, it frequently does things that kill the patient unless there is medical intervention. Your anti "fucking with this system in any way" stance is anti medicine. Go drink more raw milk.
Your points about how incredibly powerful hormones are is not the strong argument you think it is when what you're arguing is that their bodies should be ravaged by hormones that they don't want. Hormones are extremely powerful, that's precisely why a kid who doesn't want them and thinks that the hormones may kill them shouldn't get them.
On April 30 2025 23:03 Billyboy wrote: Thank you for all of those that provided thoughtful responses. Anecdotally I had/have to make a decision with my daughter that isn't this, but is something where the medical community is not in full agreement and there are different options and it comes down to parent choice. From personal experience that really sucks. The reason is, if the professional experts are not sure how am I to be? Thank goodness me and my wife are on the same page because then what? I get why the professionals are giving the answers they are, but it would sure be much easier for them to just give me an answer. They even don't really want to give advice (probably because they don't want the responsibility of possibly being wrong, but I'm in the same boat with less training and expertise).
At any rate in these complicated decisions I think we as a society need to give a lot more grace to people. The ones that would pick to do it are not hero's or villain's, for the most part they are just people trying to do the best for their kids in a world where the answer is not clear and wading through the information and disinformation is near impossible. Same for the people who decide not to.
These decisions with time constraints and long term life changing consequences are hell to make and mega pressure. Unless you are some sort person who has 100% confidence in their assumptions.
Agree with this, it's a shame that the debate/discussion isn't more focused on the practical reality and is more interested in picking sides. I think it's really important that doctors and professionals are better placed to give parents the best information and resources avaliable so that they are able to make the best decisions for their kids.
I think doctors and professionals are very focused on the practical aspects of it all, that's why they're in the field. They see the politicizing of it all as quite the annoyance, but in the end aren't all that bothered by it unless - of course - a bunch of weirdos starts targeting them because of some ideology based executive order gives them the merit/audacity to do so.
On April 30 2025 23:08 KwarK wrote: People and doctors aren't being allowed to pick what is right for the patient. The political divide here is whether we should let parents and doctors make the best decision they can for the patient or whether the politicians should decide that for them. It's not over the specific choice that is made, it's who is allowed to make the choice. The Republican Party believe that they should make the choice for everyone.
First of all your whole idea of right and wrong hormones makes no sense. Biologically the "right" hormone is the ones DNA code for. Psychologically it's the one that affirms the gender the person feels the belong to.
Puberty is a growth phase where an incredibly complex biological system are making some major changes and bringing interconnected biological, mental and psychological systems online. It's not as easy as one does male one does female. On top of that since we are a social animal all this is supposed to happen alongside finding our place in society as we transition from children to adults.
Fucking with this system in any way (as we are already doing with social media, food, medications etc) is not risk free. Not even if you delay it. The only reason it kind of works is that your body builds life support and basic function first so it's done. Hormones are ultra potent in effecting change. Try fucking around with other hormones in a younger development stage and you have a dead kid. Hell, try changing some hormones in an adult and see what happens.
Also don't let doctors decide in general. It's a terrible idea. You are always going to find a doctor willing to do whatever even if 99% of the field thinks it's a bad idea. With low evidence it should be restricted to research only so the patients end up in the correct place.
Also if this was a new heart medication the amount of required pre clinical studies required is very high. I just assume some of that is already done but as just a few examples you would like high quality cohort studies on gender dysmorphia and it's effect over long time (10-15 years) in untreated groups with a matched control cohort, studies on the effects of delayed puberty and of course the effect of adding hormones on long term health. Before you have solid evidence of that you can't do risk assessment vs benefit and you can't properly evaluate the effect of treatment.
So if the evidence is weak shore that up before even considering letting doctors start up treatments outside research.
Puberty blockers aren't a new medicine, they're an old and tested treatment for precocious puberty, a medical condition when the DNA, which doesn't always know what it is doing, sends a child into puberty way too early. The body is not infallible, it frequently does things that kill the patient unless there is medical intervention. Your anti "fucking with this system in any way" stance is anti medicine. Go drink more raw milk.
Your points about how incredibly powerful hormones are is not the strong argument you think it is when what you're arguing is that their bodies should be ravaged by hormones that they don't want. Hormones are extremely powerful, that's precisely why a kid who doesn't want them and thinks that the hormones may kill them shouldn't get them.
If you have low levels of thyroid hormones we supplement them with more. If you have high levels we remove the thyroid and give the normal dose.
If you have a chronic version of leukemia and produce to many blood cells you can get medicine to make you produce less. If you have an autoimmune disorder we might give you an TNF-alfa inhibitor to suppress parts of your immune system, or even general autoimmune medication to suppress all of it.
Try to take any of these treatments and put them into an individual with normal values and you get a sick person. I guess you can argue that giving more thyroid hormone could be a treatment if you wanted to lose weight.
"This treatment is tested for this condition" is a shit argument for other conditions.
I'm also in general not against any transgender treatment I just understand what very low levels of evidence means and think that there should be more research on the subject. And while "let the parents and doctors decide" may sound logical and good due to doctor shopping what it essentially means is that treatment is completely free to get. "Research only" doesn't mean you can't get the treatment it just means that it will happen in a better controlled clinical environment with more stringent selection, controls and follow-ups.
It's the *normal* way to evaluate new treatments (or old repurposed ones) with weak evidence.
On May 01 2025 00:18 Uldridge wrote: I think doctors and professionals are very focused on the practical aspects of it all, that's why they're in the field. They see the politicizing of it all as quite the annoyance, but in the end aren't all that bothered by it unless - of course - a bunch of weirdos starts targeting them because of some ideology based executive order gives them the merit/audacity to do so.
The majority of healthcare providers are incredibly conservative (in the medical, not political aspect) when it comes to new treatments. You generally don't want to be first with any kind of treatment, material, medication, surgical procedure or basically anything else if there isn't either solid evidence or a very compelling risk-reward ratio. It's much better to wait until it's proven and there are clear protocols.
For something like this the added political component is just a cherry on top.
It could be argued that since there are not alternative treatments and the risk is high (suicide) the risk-reward ratio is compelling in this case but there doesn't seem to be solid evidence for that either.
On May 01 2025 00:20 CuddlyCuteKitten wrote: It's the *normal* way to evaluate new treatments (or old repurposed ones) with weak evidence.
The treatment that Kwark describes for cis kids with early puberty issues is from 1980s, but the puberty blockers have been used for trans kids since the early 1990s. Apologies if you knew that, your posts read as if you think it just started, it didn't.
On May 01 2025 00:18 Uldridge wrote: I think doctors and professionals are very focused on the practical aspects of it all, that's why they're in the field. They see the politicizing of it all as quite the annoyance, but in the end aren't all that bothered by it unless - of course - a bunch of weirdos starts targeting them because of some ideology based executive order gives them the merit/audacity to do so.
I know and am related to several doctors at all kinds of levels and this is true. But political debates and social pressures can put external pressures on doctors and professionals that hinder their ability to give the best possible medical care.
You're playing some very weird games with the word "normal" here. You're creating a platonic ideal of what the body should do and saying that medical intervention is only acceptable if it moves it closer to that. Bodies don't work that way.
Puberty at four years old is a normal age for a child with a medical condition causing precocious puberty. That's normal for a child with that condition. What puberty blockers do is unnatural, they alter what the body is naturally doing. It's still something we treat because a failure to treat would have negative consequences. A trans boy's body is going to naturally produce estrogen, that's just as normal and its just as unwanted.
Speaking as a parent if my kid came to me and said that they have this medical thing that frequently makes them kill themselves and their doctor said they had a treatment for it and the research backed that treatment then I'd prefer politicians let my child have the medicine. That would be my preference because I'd prefer that my child not kill themselves. Whether that moves them closer or further away from your idea of normal wouldn't influence me.
Currently reading this because I am still working in a capitalist system which means I am still not rewarded for generating additional value, and apparently the Cass Report, which is the basis for the claim that there is weak evidence of improvement for trans kids on hormone therapy, is using systematic reviews from the University of York to make that claim. The York SRs appears to exclude studies for dubious reasons:
"Furthermore, the York SR team did not implement the NOS as it is presented by its authors. They modified the scale in an arbitrary way that permitted the exclusion of studies from further consideration, for reasons irrelevant to clinical care. For instance, in the York SR on social transition, the modified NOS asked if study samples were “truly representative of the average child or adolescent with gender dysphoria.” There is no such thing as the “average child or adolescent with gender dysphoria” —this is an inexpertly devised and meaningless concept that is neither defined by the authors nor used in clinical research. And yet it was grounds for excluding several important studies from consideration."
It also has a conclusion that is inconsistent with its own findings, even after the dubious exclusions:
"Moreover, the York SR team’s evidentiary findings and conclusions conflict. In the SR on gender-affirming hormone therapy, the “moderate and high quality” studies showed improved depression, anxiety, and suicidality (see Supplementary Table). Every study showed statistically significant improvements with a substantial magnitude of effect. No study showed a lack of improvement and no study showed worsening outcomes. It is thus peculiar that the York SR team concluded that “There was limited evidence regarding gender dysphoria, body satisfaction, psychosocial and cognitive outcomes, and fertility.” There are five studies that were classified as “low quality” and discarded. Of note, Tordoff et al101 was excluded due to scoring low on the authors’ adapted NOS. However, this study shows statistically significant reductions in depression and suicidality."
Very good conversation overall, would recommend to people who care about this topic
The most relevant part for us is from 1:19:50 to 2:05:27. The part for Drone is at 1:35:20. The part about weak evidence is at 1:39:35
Really worthwhile, watched the entire part listed, going to watch the sports part later. Another time stamp I'd point out is 158.37, it is where he basically asks what should parents do. Going to add this and look through to see if he has one on my child's situation, what a great conversation by two thoughtful and highly intelligent and knowledgeable people. Highly highly recommended.
On April 30 2025 23:03 Billyboy wrote: Thank you for all of those that provided thoughtful responses. Anecdotally I had/have to make a decision with my daughter that isn't this, but is something where the medical community is not in full agreement and there are different options and it comes down to parent choice. From personal experience that really sucks. The reason is, if the professional experts are not sure how am I to be? Thank goodness me and my wife are on the same page because then what? I get why the professionals are giving the answers they are, but it would sure be much easier for them to just give me an answer. They even don't really want to give advice (probably because they don't want the responsibility of possibly being wrong, but I'm in the same boat with less training and expertise).
At any rate in these complicated decisions I think we as a society need to give a lot more grace to people. The ones that would pick to do it are not hero's or villain's, for the most part they are just people trying to do the best for their kids in a world where the answer is not clear and wading through the information and disinformation is near impossible. Same for the people who decide not to.
These decisions with time constraints and long term life changing consequences are hell to make and mega pressure. Unless you are some sort person who has 100% confidence in their assumptions.
Add to that that the quality of care and followup is dependent on what your region is because not everyone has resources to spare. If you can't really move back and forth >100km to find a doctor that can do the best thing for you, you need to settle with locals and hope they're informed/practiced enough to give adequate care. Medicine is a weird profession honestly.
Great point, and also that there is skill differences between various practitioners, which isn't always clear or you just might not have access to the best.
On April 30 2025 23:03 Billyboy wrote: Thank you for all of those that provided thoughtful responses. Anecdotally I had/have to make a decision with my daughter that isn't this, but is something where the medical community is not in full agreement and there are different options and it comes down to parent choice. From personal experience that really sucks. The reason is, if the professional experts are not sure how am I to be? Thank goodness me and my wife are on the same page because then what? I get why the professionals are giving the answers they are, but it would sure be much easier for them to just give me an answer. They even don't really want to give advice (probably because they don't want the responsibility of possibly being wrong, but I'm in the same boat with less training and expertise).
At any rate in these complicated decisions I think we as a society need to give a lot more grace to people. The ones that would pick to do it are not hero's or villain's, for the most part they are just people trying to do the best for their kids in a world where the answer is not clear and wading through the information and disinformation is near impossible. Same for the people who decide not to.
These decisions with time constraints and long term life changing consequences are hell to make and mega pressure. Unless you are some sort person who has 100% confidence in their assumptions.
Agree with this, it's a shame that the debate/discussion isn't more focused on the practical reality and is more interested in picking sides. I think it's really important that doctors and professionals are better placed to give parents the best information and resources avaliable so that they are able to make the best decisions for their kids.
If you have not yet, watch the video linked by Neb. It is super well done, lots to think about. They even bring up, "what do you say to this person who disagrees" and often the person does not really disagree, or not completely but the way their research or paper is used politically it seems that way, or way more harsh.
On May 01 2025 00:20 CuddlyCuteKitten wrote: It's the *normal* way to evaluate new treatments (or old repurposed ones) with weak evidence.
The treatment that Kwark describes for cis kids with early puberty issues is from 1980s, but the puberty blockers have been used for trans kids since the early 1990s. Apologies if you knew that, your posts read as if you think it just started, it didn't.
All I need to know is that an independent Swedish agency with an excellent track record of reviewing evidence thinks the current level of research is uncertain.
If the treatment has been done for 35 years that just proves my point.
Weak evidence means that we don't know if the treatment does what we think it does. There are individual studies that show success but they have different kinds of bias or the measured effects were small or very likely that the sample size (number of patients) were small.
All the more reason for aggregating all patients into research centers. If the number is low it will also give them better care and it will be logistically feasible.
On May 01 2025 00:20 CuddlyCuteKitten wrote: It's the *normal* way to evaluate new treatments (or old repurposed ones) with weak evidence.
The treatment that Kwark describes for cis kids with early puberty issues is from 1980s, but the puberty blockers have been used for trans kids since the early 1990s. Apologies if you knew that, your posts read as if you think it just started, it didn't.
All I need to know is that an independent Swedish agency with an excellent track record of reviewing evidence thinks the current level of research is uncertain.
If the treatment has been done for 35 years that just proves my point.
Weak evidence means that we don't know if the treatment does what we think it does. There are individual studies that show success but they have different kinds of bias or the measured effects were small or very likely that the sample size (number of patients) were small.
All the more reason for aggregating all patients into research centers. If the number is low it will also give them better care and it will be logistically feasible.
There is nothing wrong with doing it in research centers, except on a logistical scale in that the gender clinics are already backed up as things are right now and those research centers aren't operational right now in Europe (or at least they weren't when Turban and Mike talked about it some time ago), so it might cause some loss of access to care. In the UK and in the US the focus is on banning care currently, so generally the topic is discussed in this way.
EPT
