[Gay] Gay News from Around the Gay World That is Gay

[Barrister]

The usual attack line from transphobes I see is on hormone blockers- trying to misrepresent these as exactly the same thing as taking active treatments.

Don't these affect fertility?

Not that I've heard. A google suggests they're commonly confused with hormone treatment which does.

The concern with hormone blockers is:

1. They have a demonstrated negative affect on bone density
2. There are concerns they may affect brain development
3. Something like 99% of kids who go on hormone blockers wind up going on to cross-sex hormones, so selling it as a pause until the kid makes up their mind is kind-of dishonest

[Barrister]

Aren't puberty blockers more & more questionned by medical science?
I'm pretty sure I read something about this last summer, also about the whole transitionning for teenager too.  It's a flawed process, infested by activists, rather than guided by science.

Didn't Sweden banned puberty blockers, btw?

Not banned, but quite restricted, yes.

At least in terms of trans kids.  Puberty blockers are still accepted for cases of precocious puberty.  And those same drugs are still used for things like treating prostate cancer.

[Jacob]

3. Something like 99% of kids who go on hormone blockers wind up going on to cross-sex hormones, so selling it as a pause until the kid makes up their mind is kind-of dishonest

Isn't the idea that they're being given treatment that is reversible, so if it turns out they were just youthfully foolish or some such, they can get back to where they were with no or minimal lasting harm?

If that's the case - and then folks continue to more permanent treatments once they're beyond the "youthfully foolish" stage - doesn't that suggest that they really know what they want even if young (since they continue once they're less young) rather than someone is being "kind-of dishonest"?

[Josquius]

I would like a source on that 99%.
But assuming it's true a lot of possibilities to read out of that. Maybe the psychologists are doing a good job of disuading people who aren't really trans before they reach the stage of taking blockers?
Maybe it's the opposite and they're doing a shit job of making an off road for those who are on blockers?
Maybe it's for profit healthcare eager to get the big bucks from sex change ops so they encourage anyone remotely interested to sign up ASAP?
Who knows.

Aren't puberty blockers more & more questionned by medical science?
I'm pretty sure I read something about this last summer, also about the whole transitionning for teenager too.  It's a flawed process, infested by activists, rather than guided by science.

Didn't Sweden banned puberty blockers, btw?

From what I gather they haven't been proven beyond a shadow of a doubt to have no side effects, there are investigations into various possibilities like impacting height and bone strength. But that's pretty standard for niche medicine, especially when looking at extremely long term side effects. It's hard to comprehensively prove a negative.

In the current transpanic culture I wouldn't be surprised that even if something was proven totally safe some places would still ban it.

As long as the science says puberty blockers do what they say on the tin and are safe then I see no reason to interfere for political reasons.

[viper37]

Aren't puberty blockers more & more questionned by medical science?
I'm pretty sure I read something about this last summer, also about the whole transitionning for teenager too.  It's a flawed process, infested by activists, rather than guided by science.

Didn't Sweden banned puberty blockers, btw?

Not banned, but quite restricted, yes.

At least in terms of trans kids.  Puberty blockers are still accepted for cases of precocious puberty.  And those same drugs are still used for things like treating prostate cancer.

Well, usually, prostate cancer does not develop in your teens.  Side effects for a 60 years old would be different than for a 11-12 years olds.

[viper37]

In the current transpanic culture I wouldn't be surprised that even if something was proven totally safe some places would still ban it.

As long as the science says puberty blockers do what they say on the tin and are safe then I see no reason to interfere for political reasons.

I'll try to find these articles again, but that's the problem, it wasn't "transpanic".  It was activists meddling with science and accusing legitimate scientists of "transphobia" just for doing their work.

[Sheilbh]

I would like a source on that 99%.

The two studies cited by the Cass interim review are between 95-99% - although the review notes there's not a great deal of high quality evidence in this area on many topics. I believe they're from the Netherlands and the UK so probably not profit-motivated.

It's one of the issues that they flag as part of why they're recommending more research in the area. There is a lack of clarity around the purpose of prescribing hormone blockers: is it an early stage in transitioning, or is it to buy time? Similarly is it resulting in an outcome consistent with the reason it's being prescribed? If it's a first step in a transition then it's possibly justified and those statistics are reassuring. If it's to allow time and space, then those statistics might indicate a risk that instead of providing a "pause" for an individual to explore and decide it is actually moving them onto the first step of a treatment path. And another side of that, I think, is how much is that down to physicians not having the clinical knowledge they need to support a "pause"?

But yeah there's a definite need to understand why that happens. Similarly I think it's important to understand why the young people presenting with gender dysphoria have flipped so it used to be broadly AMAB, I believe in the UK, Netherlands and other countries it's now really skewed to AFAB. Again that needs looking into.

From what I gather they haven't been proven beyond a shadow of a doubt to have no side effects, there are investigations into various possibilities like impacting height and bone strength. But that's pretty standard for niche medicine, especially when looking at extremely long term side effects. It's hard to comprehensively prove a negative.

One of the risks with them is that there isn't much research into long-term effects, which makes sense as this use of them is relatively new - it's in teens and I believe it really started in the Netherlands in the 80s or 90s. From what I've read those early days didn't set up long-term studies. Again according to the Cass interim review there's only weak and inconclusive evidence on long-term impact around bone strength - but it is a common short-term side effect.

There are side effects - but I think it's the standard question medical authorities always ask themselves: is the risk and consequence of those side effects outweighed by the benefit to the patient.

I find it quite striking that the Cass interim review seems far more wary of puberty blockers than hormones because there have been lots of long term studies so the risks are quite well understood. There are risks but they're well understood and can be explained and dealt with - the balance for physicians with them is around the decision to physically transition. For puberty blockers (in this use) it's the opposite: it might be reversible (unlike some impacts of hormones - although again there are gaps in the knowledge here too especially around brain development which is apparently a focus for international research), but the risks are less known because there are gaps in the knowledge.

[Barrister]

3. Something like 99% of kids who go on hormone blockers wind up going on to cross-sex hormones, so selling it as a pause until the kid makes up their mind is kind-of dishonest

Isn't the idea that they're being given treatment that is reversible, so if it turns out they were just youthfully foolish or some such, they can get back to where they were with no or minimal lasting harm?

If that's the case - and then folks continue to more permanent treatments once they're beyond the "youthfully foolish" stage - doesn't that suggest that they really know what they want even if young (since they continue once they're less young) rather than someone is being "kind-of dishonest"?

It's up for debate whether or not puberty blockers are reversible or not though.

https://www.transgendertrend.com/nhs-no-longer-puberty-blockers-reversible/
(site has an agenda, but sources its work)

It's certainly how puberty blockers are being talked up - that they just buy time to see if it is just a "phase", but in practice it almost invariably is just one step on the road to medical transitioning.

[Sophie Scholl]

"An agenda" is an understatement. They're very, very anti-trans and a lot of the research such TERF groups cite is either dramatically misconstrued, incredibly old, and/or done by a small minority of researchers with a matching agenda. If you want the most well researched and consensus driven report on hormone blockers, I encourage you to look up the WPATH guidelines and the WPATH's recent rebuttal to a lot of the recent attacks against blockers. WPATH being the World Professional Association for Transgender Health. They're the top organization when it comes to trans medical issues, research, and policy making and have a lot of experience and global respect for their work. They're fact based, research driven, and have a slightly progressive of center kind of take on things. They often are slow to adopt what trans people wish they would, but their word is more or less final when it comes to insurance coverage and the like.

[Barrister]

Sophie, I'm actually familiar with WPATH.   As you say they are somewhat more conservative in their treatment recommendations for youth and are probably the "gold standard" - and that certainly some activists recommend treatment way, way more aggressive then what WPATH recommends.  Unfortunately as I understand it WPATH's guidelines are far from final - lots of "gender clinics" are pursuing treatment that does not accord with WPATH's voluntary guidelines.

If you want a more neutral look at puberty blockers and trans youths (and I can't believe I didn't remember this article before) here's a lengthy NYT article.

https://www.nytimes.com/2022/11/14/health/puberty-blockers-transgender.html

(NYT is paywalled, you get a very limited number of free articles.  Try using a browser you don't usually use if you can't view it at first)

More of the article goes on about bone density, which is the most well demonstrated negative effect of PB on youths.  It questions brain development.  Rather than 99%, it cites that 98% of youths who go on PB go on to cross-sex hormones later on - so again is this "buying time to decide", or just starting on an almost inevitable pathway.

It's a tricky issue, with compelling arguments on lots of different sides.  Certainly those politicians who use the questions about youth gender transition as an argument to ban the practice entirely are just being cruel.  There certainly are arguments on why a child who has shown persistent gender dysphoria from a young age would be more comfortable to go on cross-sex hormones at the start of puberty and thus not go through the "wrong" puberty".

The counter-argument is that A: adolescent minds are notoriously under-developed, and thus not always the best at making health decisions with life-long implications; and B: these drugs have very serious side-effects (the one de-transer I know just had too many serious side-effects from testosterone and had to stop - she now again identifies as a lesbian (she was also an adult, so only tangentially a relevant example when discussing youths)).


Really in the end we just need more evidence and studies.

In what might seem like a non-sequitur but I promise isn't... I was listening to the most season season of Malcolm Gladwell's Revisionist History podcast. The topic was "experiments", and he spent a couple of episodes on something called the Minnesota Starvation Experiment.  36 young men during WWII volunteered to be, well, starved for six months.  These men suffered horribly, lost massive amounts of weight, some went on to develop life-long eating disorders or other mental health concerns - but even 75 years later most of what we know about the effects of malnutrition and starvation comes from this experiment.  And despite the fact all of these men were eager volunteers*, bio-ethicists seemed to unanimously agree you'd never be able to run an experiment like that today.  It would be unethical to knowingly harm patients in this way.

So the problem today is we have youths who are obviously suffering.  We have drugs that we think will help alleviate the suffering - but we don't really know because they haven't been studied.  But because the mindset is 'we can't allow people to suffer' we start prescribing very powerful drugs very early on.

I don't know how exactly you can study the effects of PB and cross-sex hormones on youths.  It's not like you can do a double-blind survey - it might well be unethical to deny treatment to somehow who would benefit, plus it'd be pretty obvious who is or is not getting a placebo.   But it's covered in the NYT article - we just don't have much evidence on these things.


*The men were conscientious objectors during WWII - they refused to fight, or contribute to the war effort even indirectly by say working as medics or in a factory producing war material - but by starving themselves they could help learn how to treat and recover all the millions of people starving during the war.  They generally felt it was one of the most important things they'd ever done.

[Eddie Teach]

Have to laugh, ironically, at the first sentence from a capsule review of a movie called Sergeant, in the February 1969 issue of Playboy. Apparently "faggotry" is an OK word? Such a quaint, secretary-butt slapping time.

Tongues will wag about The Sergeant, because of the explicit homosexuality in a climactic kissing scene between Rod Steiger and John Phillip Law. The scene, in fact, is an emotional shocker that conveys tragic implications well beyond the range of movies made to exploit the public's fascination with faggotry, a subject not nearly so far underground as it used to be

So you're the guy that reads the articles. 

[Sophie Scholl]

That's awesome you know about WPATH! Far too many people are almost totally checked out of trans issues and only have the most cursory, biased, and far from solid understanding of things but love to throw their voices into the discussion like they're authoritative, nuanced, and informed. It is pretty terrible to be on the receiving end of.

That being said, the article, and just about every NYT article on trans issues, comes with a very conservative political bias and is widely viewed as partisan and awful by everyone in the trans community and almost every medical professional I've seen. The NYT has been absolutely awful on reporting trans issues and also in giving plenty of ink to anti-trans advocates and almost none to actual trans people and their advocates. It is incredibly alarming and disappointing to see. WPATH actually issued a statement regarding the article and its contents (here) that rips it apart pretty thoroughly.

Also, I notice there is almost no negative commentary or output for any HRT, gender affirming care, puberty blockers, and the like when it comes to cis people. It is solely the same treatments' usage in trans people that suddenly makes them dangerous. It is remarkably disingenuous in my opinion and shows that the vast majority of such things are based more on trans discrimination than on actual science or concerns of legitimacy. 

[Barrister]

That's awesome you know about WPATH! Far too many people are almost totally checked out of trans issues and only have the most cursory, biased, and far from solid understanding of things but love to throw their voices into the discussion like they're authoritative, nuanced, and informed. It is pretty terrible to be on the receiving end of.

That being said, the article, and just about every NYT article on trans issues, comes with a very conservative political bias and is widely viewed as partisan and awful by everyone in the trans community and almost every medical professional I've seen. The NYT has been absolutely awful on reporting trans issues and also in giving plenty of ink to anti-trans advocates and almost none to actual trans people and their advocates. It is incredibly alarming and disappointing to see. WPATH actually issued a statement regarding the article and its contents (here) that rips it apart pretty thoroughly.

Also, I notice there is almost no negative commentary or output for any HRT, gender affirming care, puberty blockers, and the like when it comes to cis people. It is solely the same treatments' usage in trans people that suddenly makes them dangerous. It is remarkably disingenuous in my opinion and shows that the vast majority of such things are based more on trans discrimination than on actual science or concerns of legitimacy. 

Sophie, I don't know what to make of the notion that the NYT is "partisan" and has a "conservative political bias".   That just seems so far from my understanding of the media world I don't know where to begin.

All in all the WPATH statement calls for "MOAR RESEARCH!1" which I would totally agree with.  When it disagrees with statements from the NYT article it's generally to point out the failings in the research to begin with.

And I also have to agree with the notion that there is no negative commentary on cis HRT.  As much as pharmaceutical companies like to try and push HRT there's lots of evidence about quite serious negative side effects.  I have to admit I'm not sure what "gender affirming care" in the cis population you're referring to.  As for puberty blockers they're relatively well studied for cases of precocious puberty, but there's an obvious difference between halting a precocious puberty and pausing an age-appropriate one.

And I want to emphasize - I have qualms about some of the youth transgender care stuff going on.  Feel free to disagree with me.  But none of that applies to adult transgender care.

[Sophie Scholl]

The fact that the NYT has been so one-sided in its coverage is why it sticks out so much to myself and others. It is really strange for an otherwise pretty center to left of center publication. The difference in who and what they publish via articles, editorials, and opinion pieces is just... brutal and remarkably anti-trans. I honestly can't think of a single other topic where there is such an incredible bias at play in their efforts.

As to trans youth healthcare, a looooooot of trans adult healthcare issues can be negated in large part when tackled at an early age. Going through the wrong puberty as a trans person does, often, horrible and irreparable damage to the individual and leads to a ton of issues at the time and later in life in terms of gender dysphoria, mental health, and more. Yes, there are certainly a lot of issues to be resolved and to take into consideration, but, from my perspective, the potential good that can be done far, far outweighs the potential negatives. Especially of a hardline position like a ban on any trans youth healthcare options like puberty blockers.

[Barrister]

The fact that the NYT has been so one-sided in its coverage is why it sticks out so much to myself and others. It is really strange for an otherwise pretty center to left of center publication. The difference in who and what they publish via articles, editorials, and opinion pieces is just... brutal and remarkably anti-trans. I honestly can't think of a single other topic where there is such an incredible bias at play in their efforts.

As to trans youth healthcare, a looooooot of trans adult healthcare issues can be negated in large part when tackled at an early age. Going through the wrong puberty as a trans person does, often, horrible and irreparable damage to the individual and leads to a ton of issues at the time and later in life in terms of gender dysphoria, mental health, and more. Yes, there are certainly a lot of issues to be resolved and to take into consideration, but, from my perspective, the potential good that can be done far, far outweighs the potential negatives. Especially of a hardline position like a ban on any trans youth healthcare options like puberty blockers.

I'm sorry, I just don't see the article I quoted as being anti-trans.  It seems well researched and even-handed.  It certainly quotes a lot of pro-youth-transition voices.

As I understand it, going through a youth transition makes it dramatically easier to pass as your correct gender, and certainly spares someone the mental trauma of going through the "wrong" puberty.  But I'm not certain what other healthcare issues are otherwise avoided.  Perhaps just not needing as many gender-confirming surgeries?

And as for benefits outweigh the risks - that seems to be clearly true for individuals who are truly trans.  The question though (to which we don't have a good answer) is what number of people as kids go on PB and cross-sex hormones who subsequently desist and subsequently identify as their birth gender?  And for those who are truly trans - they still need to be aware of what those medical risks are.

And let there be no doubt I would not support banning trans youth gender-affirming healthcare.