Gender medicine: Doubts are growing about therapy for gender-dysphoric children

[janterry]

Drug treatments seem to do little good, and may be harmful

https://www.economist.com/science-and-technology/2021/05/15/doubts-are-growing-about-therapy-for-gender-dysphoric-children


Last June, though, Finland revised its guidelines to prefer psychological treatment to drugs. In September Britain launched a top-down review of the field. In December the High Court of England and Wales ruled that under-16s were unlikely to be able to consent meaningfully to taking puberty blockers, leading gids to suspend new referrals, though a subsequent ruling held that parents could consent on their children's behalf. On April 6th Arkansas passed laws that make prescribing puberty blockers and cross-sex hormones to children illegal. Also in April the Astrid Lindgren Children's Hospital in Stockholm, a part of the Karolinska Institute, announced that it would stop prescribing puberty blockers and cross-sex hormones to those under 18, except in clinical trials.

Those sceptical of affirmation therapy point out two problems. Evidence is lacking, and what exists is not reassuring. A review by Sweden's health authorities in 2019 found little research, mostly of poor quality. Britain’s National Institute for Health and Care Excellence found that puberty blockers did little to dispel gender dysphoria or improve patients' mental health (though they do not make such feelings worse). Moreover, existing studies suggest that, without intervention, most children with gender dysphoria end up reconciled to their natal sex as adults.

There is also evidence that the drugs may cause serious harm. One example is described by Michael Biggs of Oxford University in a letter published on April 26th in the Journal of Paediatric Endocrinology and Metabolism. Bone-mineral density (bmd) usually rises sharply in puberty. But of 24 gids patients who had been prescribed puberty blockers, a third had bmd scores in the bottom 2% of their age groups (more that two standard deviations below the mean, see chart). One patient, who began puberty blockers aged 12, suffered four fractures by the age of 16. That medical history, says Dr Biggs, would usually be enough to diagnose osteoporosis—normally a disease of the elderly. Animal studies suggest puberty blockers may cause cognitive damage, too. Cross-sex hormones have been linked to heart disease, strokes and sterility.

[hlthe2b]

1. I am glad I don't work in this field of medicine. Until we have unbiased answers is there

a clear answer to "first do no harm?" I have great empathy for parents trying to navigate this issue with compassion and love for their children and being pulled concurrently in opposite directions. But, yes those endocrine-blocking drugs are NOT benign.

I just hope we can get some clarity with ongoing study and without external forces or politics overriding.

[janterry]

3. Way to little GOOD research in this area

I think that's true throughout the field (gender dysphoric adults and kids).

For instance, you can find LOTS of press for a study that 'proved' hormones and/or surgery helped gender incongruent patients.

It was published in a major journal -American Journal of Psychiatry (it is cited all over the internet). And yet, nary a word that the studies findings are not valid (this correction was just issued).

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.1778correction

After the article “Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study” by Richard Bränström, Ph.D., and John E. Pachankis, Ph.D. (doi: 10.1176/appi.ajp.2019.19010080), was published online on October 4, 2019, some letters containing questions on the statistical methodology employed in the study led the Journal to seek statistical consultations. The results of these consultations were presented to the study authors, who concurred with many of the points raised. Upon request, the authors reanalyzed the data to compare outcomes between individuals diagnosed with gender incongruence who had received gender-affirming surgical treatments and those diagnosed with gender incongruence who had not. While this comparison was performed retrospectively and was not part of the original research question given that several other factors may differ between the groups, the results demonstrated no advantage of surgery in relation to subsequent mood or anxiety disorder-related health care visits or prescriptions or hospitalizations following suicide attempts in that comparison. Given that the study used neither a prospective cohort design nor a randomized controlled trial design, the conclusion that “the longitudinal association between gender-affirming surgery and lower use of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them” is too strong. Finally, although the percentage of individuals with a gender incongruence diagnosis who had received gender-affirming surgical treatments during the follow-up period is correctly reported in Table 3 (37.9%), the text incorrectly refers to this percentage as 48%. The article was reposted on August 1, 2020, correcting this percentage and including an addendum referencing the postpublication discussion captured in the Letters to the Editor section of the August 2020 issue of the Journal

[Loki Liesmith]

2. That's definitely an issue for increased study

Last edited Fri May 14, 2021, 07:43 AM - Edit history (1)

Also would like to know what’s behind the massive spike in teen girls expressing gender dysphoria lately.

[janterry]

4. This really needs to be understood

I've seen this locally (first hand, in a local school) - but that aside

those spikes are true in most developed countries. Sweden has issued a statement saying that there is a 'triggering' event.

[OneCrazyDiamond]

7. I could be wrong, but

I think it is a more open society enables them to be who they are on the inside without reprisal.

[Loki Liesmith]

8. Why girls at such a higher rate than boys then?

[OneCrazyDiamond]

11. .

[janterry]

9. This is one hypothesis

Of course, there are competing ones. And the problem is, then why aren't boys identifying at the same rates? Why just girls (across different countries).

The biggest worry remains, the detransitioners. They are the ones who are suffering (permanent changes, often. It's heartbreaking).

We don't hear about them in this country. But that's what led other countries to start to explore what might be happening.

In any case, if your hypothesis is true - that girls are more free to explore gender - and that was leading the change - and we found the real numbers for desistance/detransition (we don't have those, I keep seeing the same false - old statistic that it's less than 1%. That is no longer accurate and any honest researcher knows that)

If we knew those (in the US) then we'd be on firmer ground to affirm your hypothesis - or challenge it.

We just don't know. We need to figure that out.

[OneCrazyDiamond]

12. We do need more study.

That way we can best help our children.

[lagomorph777]

5. Watch the series "I Am Jazz" for up-close view of how it goes.

She has multiple friends; some had access to the treatments, some did not. You can compare all their experiences.

My overall impression is that the ones who got it were happier than the ones who didn't.

[janterry]

6. I've not seen it, but for sure it's one of the problem areas

the early introduction of medication made the surgeries more difficult (there wasn't enough penile tissue to work with). When you disrupt puberty, you are (with biological boys) left with anatomy that isn't sufficient for a (more straightforward?) surgery.

I know the operating surgeon commented on that (one of the reason they needed additional surgeries). I hate commenting on their sexual..... (geez. I hate this. But they haven't yet had the ability to orgasm. This was self-reported on the show - so I guess there is the idea this is part of the reality TV show - in public domain. Still HATE it. One of the reasons I don't watch reality shows of any kind ).

Anyway, it's one of the worries about early intervention.

Of course, they also suffer from depression and that's a different issue (well, hard to say - how they engage with each other). So, for sure, Jazz has had a hard time recently from what I see reported

[lagomorph777]

13. Yes, it had detrimental effect on surgery and sexual function...

But the effect on self-image and long-term appearance seems to outweigh that for Jazz and her friends.

[janterry]

14. I hope so

I think only time will tell.

The old research suggested that most gender non-conforming children who go through a normative puberty will reconcile with their natal sex (generally, they will simply grow up to be gay).

We appear to have lost that as an option for gender non-conforming kids in the USA. But that is what they are reverting to in some of the countries that are noted in the article.

I have no doubt that, for a (small?) subset of children early medical intervention could be helpful. Clearly, some adults who have gone on to SRS look back and wish for that (as young children).

The problem remains how to tease out the two. Who would do well with a medicalized pathway and who would not.

Have you watched Transtrain (you can find it online). It changed things dramatically in Sweden.

[Loki Liesmith]

10. It's hard to disentangle that from the fact that testosterone is a mood booster

At least for females. Females experiencing depression are going to feel a lot better if you give them T.

[shrike3]

15. Renee Richards' take on it.

You have to be very careful, because not all of these kids that are professing their identity at 6 or 7 stay with it. You can’t just say to that 8-year-old, "Yes, you can go on the path now of becoming a transgender," because it’s too early. The most extreme ones, who are putting themselves forth in the world even at the age of 6 or 7, yes, they probably will be. But there are a lot of kids in the middle there who profess one day and don’t profess it the next day, and you can’t start treating them too early. One big advantage that has come about is what started in Holland a few years ago. Holland is often ahead of the curve in a lot of social and ethical issues. They started with the hormonal blockers in the boys that profess they wanted to grow up as girls. These hormonal blockers block puberty for a few years, to give these preteens and teens time to really decide whether that’s what they want to do. They don’t grow beards. They don’t have male faces. They don’t have male bone-skeleton development. It blocks the formation of testosterone, so they don’t develop the male body, which is so hard to deal with at a later age. And then, when the boys get to be 16 [and still want to proceed], the surgery is a much easier way to go. So what do I say to an 8-year-old? I say, "Be careful. Explore the operation, explore the opportunities, explore the options. But hold off on anything that’s not able to be undone."

https://www.gq.com/story/renee-richards-interview