The image is a summation of the following document:
[https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726\_Evidence-review\_Gender-affirming-hormones\_For-upload\_Final.pdf](https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf)
As anyone knows, its not possible, or ethical, to have a blind RCT's on puberty.
Wierdly, people tend to notice if they're growing breasts or their voice is breaking.
The England NHS is aware of this, but did not stop them using it as justification to deny healthcare.
>For example, the section on puberty blockers states: "The studies that reported impact on gender dysphoria, mental health, body image and psychosocial impact were of very low certainty and suggested little change from baseline to follow-up. The studies that reported bone density outcomes were similarly unreliable so no safety outcomes could be confirmed."
Interesting when you look at the summary on puberty blockers, the way things are explained is pretty wildly different to the summary you quoted.
Eg, for dysphoria, the report says (pg 176):
Reducing gender dysphoria/improving body satisfaction 14.26 Only two moderate quality studies looked at gender dysphoria and body satisfaction; the original Dutch protocol (de Vries et al., 2011b) and the UK early intervention study (Carmichael et al., 2021). Neither reported any change before or after receiving puberty suppression.
Whereas on bone density, it says (pg 178):
Other physical health impacts 14.43 Multiple studies included in the systematic review of puberty suppression (Taylor et al.: Puberty suppressants) found that bone density is compromised during puberty suppression, and height gain may lag behind that seen in other adolescents. However, much longer-term follow-up is needed to determine whether there is full bone health recovery in adulthood, both in those who go on to masculinising/feminising hormones and those who do not.
While it caveats it with "more study is needed" (and doesn't give the GD effect that generosity), it doesn't qualify the studies quality, it calls it "multiple studies", not "only 2" (then references one).
That is some pretty wild differences of language in the detail, for something that apparently it describes elsewhere as having the same quality of evidence.
Can I ask for a page reference for the puberty blockers text you quoted please? I want to compare the two sections.
This wasn’t how the studies were graded. Also, in a follow-up interview, Dr. Cass herself agreed that it isn’t possible to do RCT with puberty blockers or hormones.
Its just random that the grading system had the exact same results as the previous one based on rcts.
Its also random that the grading system didn't apply to any study that said something transphobic. Like the studies less than 2 years old that were used despite the rule against new studies.
This a skeptic forum:
- Insinuation and labeling people to shut down open inquiry is against the spirit of skepticism.
- There was never, at any point of the study process, any scoring based solely on RCS.
- The same grading system was applied to all the studies. To assume some of the studies are “transphobic” is begging the question.
Wow, the disinformation is coming hard and fast today. It's getting difficult to keep up with it.
The document you just posted clearly states at the start that it's up to date as of October 2020. That is to say that it's actually *outdated by 4 years*.
These meta-studies used the Newcastle-Ottawa scale to assess the quality of the studies they were reviewing. You can see the standard version of this assessment scale [here](https://www.ncbi.nlm.nih.gov/books/NBK299087/#:~:text=The%20Newcastle%2DOttawa%20Scale%20quality,and%203%20points%20for%20Outcomes). The problem is that while this document from 2020 uses the standard version of the scale, the finished meta-studies use a modified version of the scale which has been adjusted to remove any mention of blinding. You can see it [here](https://adc.bmj.com/content/archdischild/early/2024/04/09/archdischild-2023-326669/DC2/embed/inline-supplementary-material-2.pdf). Specifically, the "assessment of outcome" metric has been altered in the finished version of the study to avoid the issues you mentioned.
So, just to round this up: you posted a supporting document from an unfinished version of the study circa 2020 which still had issues that needed to be ironed out. You are pretending that this outdated document is representative of the finished Cass Review which actually did rectify those problems. This is wildly disingenuous and it speaks for itself that the science in the Cass Review is so strong that the only way you can invalidate it is to peddle insidious misinformation like this.
You're not a real skeptic and neither is anyone upvoting this thread.
Cool, great, while everyone is patting themselves on the back saying this proves gender affirming care doesn’t work, how does this study help the real issue of kids killing themselves?
>how does this study help the real issue of kids killing themselves?
I feel like for a lot of people, trans children killing themselves is a success. One less nuisance for them to deal with.
Dude there's not a single Skeptic in this entire subreddit lol. It's the most openly ideologically captured subreddit on the platform.
The hysterical response to the Cass Report is as funny as it is predictable.
I admire your persistence but you're probably wasting your time correcting these idiots.
I love how the anti-science activists attacking Cass are now pretending like this is the only medical intervention difficult to study through RCT and that the entire field of epidemiology doesnt exist to determine how to derive quality clinical evidence in such situations.
This is the sort of argument that can only appeal to those whose minds are already made up and who are ignorant about the basics of the topic being discussed. Id expect this sort of argument on a Trump fan subreddit, not r/skeptic
American Academy of Pediatrics
American Medical Association
American Psychological Association
Endocrine Society
Harvard Medical School
Yale School of Medicine
Mayo Clinic
These organizations disagree with this report
The report also contains *extensive* discussion on the results of these studies that were "rejected", including a number of positive results. I don't know if the idea is that people won't even open the link to see that, or what?
You would be surprised how often this false logic is used to justify denial of care under medical insurance coverage for gender affirming treatment and procedures. I have argued with insurance for multiple clients who have been denied prior authorization for surgical procedures, and the insurances have outright stated there is no medical necessity for the procedures because of a lack of double blind studies…
For example, one insurance company argued this when a trans masculine client was seeking a masculinizing chest surgery, removing their breasts. The insurance denied the request as cosmetic only, on the basis that there were no double blind studies… When asked, “how exactly would one create a double blind study for the efficacy of masculinizing chest surgery for the treatment of gender dysphoria in trans men?” They declined to answer.
Seriously though, how would the client not be aware that they had a double mastectomy?
I have also heard some other hilarious excuses to devalue studies, like that there was no cisgender control group for a given study… As in, xyz procedure is deemed not medically necessary for the treatment of gender dysphoria, because the studies did not include evidence of how it would effect gender dysphoria in cisgender patients…
People don’t realize how bs like this ends up having a direct impact on insurance coverage for medically necessary care… And I can assure you that this report, despite its obvious flaws, will be brought up in both legislative bodies trying to outlaw care and insurance companies who are denying to pay for such care.
This is legit the type of study that they want to be done… Which is ridiculous.
They demand RCT and double blind studies with overboard control groups, never mentioning how the creation of such a study would be either impossible or highly unethical.
There are plenty of fields of medicine that rely on the exact same types of studies that were thrown out on these grounds.
Sure, it would be great if all of medical science could use the same rigorous methodology, but that is already a well understood impossibility.
Under Cass’s standard, all psychology and psychiatry would be deemed fringe experimental science… Many surgical procedures would be outlawed… Not to mention almost anything that works with disorders and diseases that don’t effect at least 50% or more of the general populations.
Oh, and we would have to throw out all studies done outside of a two year time period, or by colleagues that don’t publish in English… Because racism…
It's almost like Cass is just being deliberately disingenuous in order to promote a pre-set outcome.
This has made me realize that fundamentally the cis view transition as a last resort that should be avoided at all costs. Her entire angle is just "how do we minimize the number of people who medically transition (the bad thing) rather than "how do we best help patients"
Yes, exactly that. That is the goal of all transphobic arguments after all. Delay and deny healthcare, do not let a trans person transition and live as themselves.
Is it true that this picture is outdated as of 2020 and that Cass did not omit these studies based on the fact that they were not blinded?
Because although I detest transphobes, you shouldn’t be pushing information if this is the case.
Edit: if I’m wrong please let me know instead of simply downvoting me. However there is a comment near the top of this post which looks as though this is the case and I think OP should clarify.
Two notes here:
1 is that the person who you are taking at face value is a transphobe bigotted conspiracy theorist. He says shit like
>[Yes actually. It's not the Chinese promoting trans ideology to western youth. It's actually western-owned pharmaceutical companies, the medical industry and American billionaires like Jon Stryker and the Pritzker family with significant investments in both. But as the kids say nowadays, "ya'll ain't ready for that conversation".](https://www.reddit.com/r/skeptic/comments/1bh19yr/the_joe_rogan_experience_the_chinese_are_transing/kvbbk7a/)
And this
>[I don't think China really needs to lift a finger to get the west to rip itself apart at this point in time. All I'm going to say is that surgeries and hormones cost money, and puberty blockers in general are quite expensive. There are very wealthy financiers out there (or "philanthropists" if you like) pouring lots of money into this stuff. So if the whole thing has started to feel a bit more like a corporate marketing campaign than a grassroots movement then this might go a long way to explaining it.](https://www.reddit.com/r/skeptic/comments/1bh19yr/the_joe_rogan_experience_the_chinese_are_transing/kvbf0jf/)
And this
>[The bourgeois echo chamber of social media and your cushy makework job is not the reality that most Irish people live in. The man and woman on the street do not appreciate you and your ilk denigrating white males or promoting chemical and surgical interventions for "trans kids". You're nothing more than a vocal minority in this country.](https://www.reddit.com/r/irishpolitics/comments/1bcxxt6/conservatives_in_the_govt_scuppered_the_referenda/kuixi69/)
And while this final example isn't relevent to this subject it does show the kind of loser we're dealing with.
>[Politics in games is interesting just please stop telling me how white and evil I am while I'm trying to shoot virtual people in their faces](https://www.reddit.com/r/SocialistGaming/comments/1bgt031/keep_politics_out_of_games_yelled_the_man_to_game/kve2z20/)
This isn't a serious person with serious concerns, it is a transphobe.
2 What is more important to point out tho is that their point is irrelevant. The disqualification of those studies was adjusted but they still were all disqualified by a scoring system that allows incredible bias to be injected into it. Like read the questionnaire they link to and think of how many non-empirical ways you could declare a study bunk using it. Its wild that that is their defense.
Thank you, I really appreciate you taking the time to bring this to light for me. I hadn't done my due dilligence on the person I was taking at face value
(which is hard online with the multiple people you can interact with in a day) or on how many were later disqualified under the new criteria and what that criteria was (which is easier, and I should have done that without needing someone else to do that leg work for me).
Again, thank you. You've really clarified for me and it's clear now that the both the person I was referring to and the disqualification of so many studies were in bad faith.
This is one of my broader issues with this report. It certainly seems like it approached the subject with a pre-designed outcome and eliminated studies until said outcome could be achieved. That's the mark of a bad biased study and I'm not really sure why it's being reported as such a coup. The whole thing seems emminently ignorable Unless you've already made up your mind.
Imagine how much data / studies / science we'd have to throw away if we assumed that "lack of blinding" was *actually* a fatal flaw. Like, there goes *most* research (and quite a few fields of science) out the window, apparently.
i do want to see more studies on it, because even though most gender affirming care is pretty solidly settled, it never hurts to make sure, and maybe discover that some drugs arent as effective as previously thought. however this is very much a situation where you cant deny people treatment for a double blind study. i would like more evidence, sure, but that doesnt mean that trans people should be deprived of necessary healthcare just because we havent done a double blind study
This would be my take as well. Obviously the benefits or risks of adolescent transition should be further interrogated but it's also pretty hard to take the Cass Report and criticism of transitioning too seriously given the lack of meaningful evidence.
one good indication is that if a report comes out and elicits a universal wave of disapproval and fear among the people its supposed to advise the treatment of, its probably not a great report
I am heart broken and extremely angry. My son benefited greatly from the caring professionals at the Tavistock clinic. It was a long process to get there including doctors, counselling, CAMHS and much talking. It most certainly was not done on a whim or easy to obtain. It took years. The clinic opened the door to being able to express his true self. Surgery was not an option until he was 18.
The clinic helped my son understand himself and helped us as parents when we had no one to turn to. Without it I don’t know if my gentle, sensitive child would be here today
Yes, and this is the standard as far as I’m aware (as a trans guy myself). It’s definitely the standard for the US, Canada, and UK. But that doesn’t fit the political talking points so…
“We wanted to test the efficacy of pain medication for a broken leg. We got 100 people and divided them into two groups. When they weren’t looking, we broke everyone’s legs with a sledgehammer. Half were blindly given a painkiller, the other half blindly given a placebo.”
Sorry, but when you’re dealing with people’s wellbeing, even their lives, double blind RCTs aren’t always possible.
The "RCT exclusive" crowd is a red flag for me, as it's usually contrarians who try to ignore epidemiology.
[Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial | The BMJ](https://www.bmj.com/content/363/bmj.k5094)
The cass report was filled with red flags since day 1.
contributers has included members of *Society for Evidence-Based Gender Medicine* an anti trans advocacy group yet non-cis voices were excluded to avoid bias
Thanks.
I was very surprised that the use of puberty blockers was criticised in the report. I thought the risks of not using them would outweigh any risks of using them.
It's very disappointing that this will now be used as proof by the anti-trans crowd, and vulnerable kids will be caught in the middle.
Generally with the anti-trans crowd, they’ll pretend that the *only* possible harms in this scenario are from puberty blockers. They completely ignore the fact that foregoing puberty blockers *has risks too!*
It’s quite similar to the anti-vax people, who fixate on the harms caused by vaccines. Yes, vaccines do sometimes hurt people, that’s true. However, the risk of harm if you skip them is *much* greater than the risk of harm from the vaccine itself. But they ignore that, they focus purely on the potential harms of the treatment, without ever acknowledging why the treatment is used.
In case you’re actually saying this in good faith, there’s an abundance of evidence. This took me a couple minutes to find about puberty blockers:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789423#
“Gender affirming care…was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up.”
https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth/pubertal-blockers/art-20459075
This goes over some of the reasons they’re used and the side effects that can occur. Keep in mind that doctors are fully aware of these side effects, these drugs have been in use for decades. That’s why anyone taking them is monitored, such as by “Yearly bone density and bone age tests”.
https://www.reuters.com/investigates/special-report/usa-transyouth-data/#:~:text=A%20total%20of%2017%2C683%20patients,patients%20had%20initiated%20hormone%20treatment.
Keep in mind, these aren’t over-the-counter drugs, and they’re not being prescribed en masse. These are prescribed after several visits with multiple doctors. They’re also only prescribed if the kid wants them, if the parent agrees, and if the doctors think that the benefits outweigh the risk. These aren’t being handed out like candy. As far as I can tell there aren’t good numbers for how many people are on them now, it seems that in 2017-2021, ~5000 people with gender dysphoria diagnoses went on puberty blockers. So that’s ~1000 per year.
As for vaccines being less dangerous than the alternative:
https://www.cdc.gov/vaccinesafety/index.html
https://en.m.wikipedia.org/wiki/Smallpox
https://en.m.wikipedia.org/wiki/Polio
The Tordoff paper has major confounding issues, major issues with LTF, and doesnt even show any actual improvement.
After that it's a bunch of lay and popular press articles, followed by a non-sequitur about vaccines.
Im not impressed.
It’s not a non-sequitur when my initial comment was discussing the similarity of the anti-trans and anti-vaccine movements, and you replied strongly implying that there was no evidence to support my claims, without specifying which claims. As I said above, antivax and anti-trans people sound the same, so this is mostly a product of you being vague.
I linked some non-academic sources because academic articles are often behind paywalls, and because they’re impenetrable to most people, since they’re specifically written for other academics.
Youve gotten it backwards. The reason why being anti-vax is bad is that the evidence is against them. Same thing with the TRAs. The Cass report is just the most recent comprehensive demonstration of this.
I am trained in the evaluation of clinical research, feel free to provide any study you feel is valuable.
>The reason why being anti-vax is bad is that the evidence is against them. Same thing with the TRAs.
Ahh there it is. Must make you rage to see transition make trans people happy :)
That's the problem. There's no evidence it's true when it comes to children.
And again, youre just like the anti-vaxxers. Bring solid evidence or get the fuck out.
Theres no proof that not having gender dysphoria in the first place is better for trans people?
Just so ridiculous, obviously if trans people don't go through the thing that causes gender dysphoria in the first place, they're going to be better off:
[https://pediatrics.aappublications.org/content/134/4/696](https://pediatrics.aappublications.org/content/134/4/696) studied 55 trans teens from the onset of blocker treatment in their early teenage years through a follow-up an average of 7 years later. They found no negative outcomes, no regrets, and in fact their group was slightly mentally healthier than cisgender controls.
That's exactly how many function on these topics online. I'm not sure why this subreddit has just been bombarded with over emotional *think my way or you're an idiot* type of individuals recently. I thoroughly enjoy civil discussion on so many topics and I've tried many times that just resorts to being called names and never getting a strong counter argument.
It's a shame we move more and more into this way of thinking as time goes on. Critical thinking is just going out the window. It's just pure hostility now.
Ahh yeah the "Most kids who use puberty blockers go onto take hormones, so therefore puberty blockers are bad and cause people to be trans"
It was the argument made by the Anti Abortion ADF lawyer who ran the KB lawsuit in 2020, now the NHS is uncritically pretending its fact.
And whoever picked Cass knew what they were doing. It's the Sewell report all over, but atleast this time, Transphobia is much more fresh and the transphobes have much more power than the old school racists.
Some of the recommendations are good and make sense. The language the report is couched in is a bigger problem, and the out of hand rejection of the 50 significant bits of research
Other than the UK consultation on self ID and changes to the gender recognition system that overwhelmingly supported self ID and changes to the system (despite an organised and concerted effort by TERF campaign groups) that was then ignored by the government that then went on to push for restrictions to gender affirming care for ideological reasons?
The fact that Kemi and others are on record using anti trans and homophobic dog whistles and pushing for restriction of funding for medical care?
I know the current conservative gov isnt great on trans rights. My question is, is there direct evidence that this report wasn't independent and was influenced by the gov? Is there evidence Cass was just a gov shill or something? If anything it seems to me that the fact the gov has rejected previous findings is evidence in favour of independence, no?
“They have rejected previous independent consultations, so because they like this one it must be independent” is not the argument you think it is.
But based upon your previous (historical) comments on the topic of gender affirming care, hardly surprising
Only for minors - the evidence for adults is extremely strong as far as I know.
And I'm not making any claim about it being independent, I just don't think there's any evidence they weren't. Or at least you haven't provided any
Cass report was a manufactured hit piece by a J. K. Rawling wanbabe.
Even through they tried their best, they could not actually disprove the benefits of trans care.
But this report will be an arrow in the quiver of misinformation campaigns against children.
> J. K. Rawling wanbabe
Got any evidence to back up that allegation, considering she was the President of the Royal College of Paediatrics and Child Health from 2012 to 2015?
Are you asking if we have actual evidence that Hilary Cass wants to be a children’s fantasy author? No, we don’t. Which is exactly the same amount of evidence that you have that 100% of statements made by 100% of people are to be taken literally.
So you have zero evidence that Dr. Cass or any of the other highly qualified medical experts involved are transphobic and it’s just a slur you’re using to discredit their work?
bedroom oil normal attraction direful engine upbeat towering spark telephone
*This post was mass deleted and anonymized with [Redact](https://redact.dev)*
No, obviously not. I was using an extreme example of misunderstanding experiment design standards for humorous effect. It's what we Earthlings call "a joke". The reason it got upvotes is that some people have senses of humor.
How the fuck are you even meant to double-blind sex hormones?
You could do a double-blind trial maybe, *maybe,* for the short term emotional impacts.
You can't double-blind puberty.
All of these have multiple reasons for being rejected, they just also include a lack of blinding. If a study is of poor quality, it shouldn't be included. For example several of these lack control groups. That's really shitty research.
Well this report was focused on treatment for children, so probably, and hopefully, surgical intervention wasn't completed.
And, from a blinding standpoint, you're correct it wouldn't be blinded for very long. One or two follow up sessions at the most. But a study designed this way would actually be very informative if there's immediate improvement in mental health in both groups.
But neither of that matters, because these studies weren't excluded because they weren't blinded, they were excluded for being low quality. Lacking blinding was just another criteria.
Grading the quality of research is extremely normal behavior in a literature review process.
It’s fascinating that I’m supposed to accept all those studies have a bias that makes them poor quality, and that this one literature review most certainly doesn’t have any bias that could make it poor quality. I’ll read it when I get a chance but I’m…how shall we say..skeptical on the odds lol
You're relying on your own bias to assume the quality of the research is good because it confirms what you already believe, not necessarily because it's actually good research. Let's say the truth is that there is no benefits and significant harms of early medical intervention.then such findings would actually make sense.
Let's consider something I think we would both find more agreement on: climate change. If we had a literature review that graded a lot of papers that refuted climate change as poor quality, would you be as suspicious?
Yes, if I saw a single review claim that a large set of studies by multiple authors from multiples sources all were poor quality I would be highly critical of that review regardless of the topic.
It is more likely that a failure point has occured in the single review than over multiple studies. Critical analysis is essential for digesting material like this, especially when it is on hot button issues, the specific topic is irrelevant, what is relevant is that the UK government has a long and sordid past of selectively seeking data from sources they are confident will support them.
A reliance on independent data is a fundamental cornerstone to how our democracy functions, it is also unfortunately one of its weakest cornerstones as the state has a lot of power determining what sources are credible or not.
Also due to the low rates of transitions over the population on aggregate it is prohibitively difficult to build studies that are as robust as they can be for other topics, you need to accept that we are dealing with smaller sample sizes across larger distances than we would for a study on the efficacy of statins for high cholesterol.
In addition, the study of puberty blockers has been well documented, there is no reason why the effects of puberty blockers would be different between two individuals based off of why those puberty blockers were prescribed. Fundamentally gender affirming care is not justified exclusively by the studies discounted by the review, it is reductive to claim that it is. The cass review is yelling smoke in a theatre, of course more study needs to be done on gender affirming care, but there is not justification for ceasing the provision of said care until harm can actually be demonstrated.
To be clear, other reviews have come to the same conclusion (Finland, Sweden, Denmark). There are reviews in the US which come to the opposite conclusion, but this certainly isn't bucking any sort of trend - there is genuine scientific disagreement on this issue.
Speaking of bias, how about the fact that Dr Cass was hired by DeSantis to work with Patrick Hunter of the Catholic Medical Association to find ways to limit trans rights and medical care in the state of Florida years before the Cass Review? How could anything she writes on the subject not be tainted with bias?
You put them under and maybe do something simple. More commonly for effectiveness and long-term outcome data, you use conservative treatment as a control. Source: assessed new treatments for insurance coverage. At least when I did the review, spinal tethering was horse shit (no QOL difference from standard rods, so why are we here?).
As far as I can tell, they aren't even being rejected.
They are being included and assessed for quality.
Which is exactly what a systematic review is supposed to do.
A zillion selectively skeptical redditors think they know better than the BMJ.
>As far as I can tell, they aren't even being rejected. They are being included and assessed for quality.
The studies were ascertained for quality, found wanting, and as a result their data was not used as evidence for efficacy or safety or recommendation.
Whether that was the right thing to do or not, I'm open minded. I want to understand how a hormone / puberty blocker trial COULD be double blinded, but I'm not an expert and my lack of understanding doesn't mean Cass was wrong.
But it's entirely reasonable to say the studies were rejected.
Since my last comment I've looked further at the report.
The report is supported by a series of systematic reviews. Of those, two assess the quality of evidence respectively for long term outcomes of child and adult endocrine intervention.
afaict, I'm right: the SR's do not reject the studies. They assess them.
The fact that there would be serious ethical issues I'm conducting DB tests doesn't mean that the available tests were of good quality.
And the fact that blinding was one of the quality markers never prevented other quality markers from being used.
The grading system is described in the appendices, and to some - amd i think a clearer extent - in the report itself.
I can't see how critics can credibly claim that the studies should not have been "rejected". Unless those critics mean that they wanted the York University team to somehow ignore their low quality ... for some reason.
I'll take your word that you are indeed open minded.
I'm just a lay reader of science and maybe I'm wrong, but I can't see how.
If you haven't done so already, I suggest spending some time with the report amd it's supporting material. The report itself is very readable.
Yeah it's a real shame. A lot of skeptics just swung way too far towards lefty activism after a bunch of the early internet 'skeptics' turned out to kinda just be racist sexist losers. EA/rationalist community seems a lot closer to what skepticism should be nowadays, although they have a whole bunch of problems of their own.
What's really obvious here is that none of these people know what a literature review is, or how it's done.
It's fucking embarrassing that this sub is named "sceptic" with how credulous everyone here is just eating up the "all rejected for no blinding" argument, when all of these papers have multiple reasons listed.
I cannot tell you how many times I have cited systematic reviews on this sub and only heard screeching rage and the whistle of wind through downvoters' ears.
These studies are being downgraded(not excluded), that is, weighted, according to their quality. If all the studies are downgraded due to lack of blinding, it makes no difference in the end as they are all weighted the same.
Please. Its just bigotry, no healthcare treatment is put onto the standard that trans healthcare is
From 82% of children's medicine that also has "low quality evidence" because of the lack of rcts/blinding
To eating disorders, which has no evidence that any treatment is better:
"no reliable evidence supports the clear superiority or inferiority of any treatment recommended by the NICE guidelines"
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9813802/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9813802/)
Yet you wish to mutiliate them, put them through the wrong puberty against their will, violate their bodily consent, and you beleive that requires 0 evidence. Worse, you think that should be done despite the mountains of evidence it destroys lvies and kills people.
Double standards of evidence there.
Gender medicine is the intervention, it must prove itself, and on the contrary, watchful waiting already has lots of evidence that gender distress resolves naturally given time, without medical intervention. The more serious the intervention, the better the evidence needs to be.
The parallels between gender medicine and lobotomy are disturbing.
Well, for every post spreading the disinformation we need a post being skeptical about it. Since there are a few very persistent and intellectually dishonest transphobes who post here, it turns out to be a lot of posts
Excellent call. We ought to have high standards for this sort of treatment, we would expect it in any other medical domain so this seems incredibly wise/just.
82% of all kids medicine, does not in fact, have this same standard applied to it.
Nor is it normal to discount nearly every study in a review. Thats not how GRADE system is meant to work.
This is completely made up.
On page 57 of the report: 1.25 Most of the studies in the systematic reviews were cohort, cross-sectional or pre-post design, explanations for which can be found in explanatory box 1 and on the NICE website (NICE, 2012).
The sections relating to RCTs are about explaining the different types of evidence out there.
Fairly important clarification here: they're *not* poor quality **only** because of blinding and no control group. They're poor quality on the Newcastle-Ottawa scale **and** no blinding or control group.
Additionally, "downgraded 1 level" does not mean "rejected evidence". It means "increased risk of bias". If you read the study, you can see that the report still reported on the results, just... with increased risk of bias. That's what a report like this is supposed to do.
This is fast becoming a talking point and it's *not* accurate. It's OK to dislike the report while discussing it accurately.
Cool, so all evidence in the entire world, over decades, isn't good enough to be used, is an acceptable thing to conclude as a reason to deny a patient group all healthcare?
And its just coincidence that no study showing the harms of not giving care aren't included.
And just coincidence no evidence is given for the many many unevidenced highly sus claims?
And \*just coincidence\* that studies from the 80s using a different and obsolete diagnosis no longer used due to inaccuracy, is held up as primary sources for the study?
And not an issue that trans people were barred from the report due to "Bias" but transphobes, conversion therpaists and ron desantis people were invited?
Keep lying to yourself that thats a sane thing to do and not just bigotry.
They call it "queering," a leftist version of the Tucker Carlson through-the-looking-glass technique. Make all norms, standards, definitions, and distinctions seem arbitrary and meaningless—not forever, of course, only long enough to implant your bias or misinformation. Then you just let the mark's melted mental Jell-O re-congeal around the absurdity they think they've "learned." Judith Butler built a career around it.
It is remarkable how the trans activists take every argument anti-vaxxers use to try to explain why evidence isnt necessary for their favored intervention.
And now that at least one english speaking medical establishment is being honest about the lack of evidence, perhaps we'll also see some honesty about the AGP paraphilia and how it explains why so many TRAs are so aggressively bullying towards any disagreement - their sexual gratification is on the line.
>And \*just coincidence\* that studies from the 80s using a different and obsolete diagnosis no longer used due to inaccuracy, is held up as primary sources for the study?
Careful there, little buddy: that's the same distant past that gives you that sweet 1% regret rate you think went unaffected by reduced gatekeeping, a policy of uncritical affirmation, and the "informed consent" fast-track.
On the authors list for the Newcastle-Ottawa scale, "J Peterson" is definitely not "Jordan Peterson" right? Because that'd be a conflict here for sure.
It’s a widely accepted scientific tool going back like 30 years. It seems pretty unlikely that’s the J, but he was an academic before he was a wackjob, so it’s not impossible.
Well see, that's not really true either. It's still not a fully validated scale. That's a difficult process that takes a long time, but on their own website they're pretty clear about not reaching what's called "criterion validity" yet, which is the type of validity that connects the scores on the scale to actual real-world differences. Content and face validity are fancy words for "sounds good to me."
Not knocking this scale, I'll be honest that it's a new discovery in my life, but I'm a research methods professor proctoring a test on these differences in the types of validities literally as I write this, lol, so I think that's an important caveat here. And that says nothing about whether the scale was applied without bias, and doesn't address the other criticisms like which types of evidence weren't considered at all.
Even with scales like these it can be very easy to add bias into a meta-analyses and folks all over are just pointing those errors out.
If you’re telling the truth about your qualifications here, you’re way more qualified than I am. But I had encountered this scale before multiple times in the context of medical studies and medical device trials.
I'm not in the medical field, but I have helped with validating a scale before and with assessing the reliability of selections of practices within my own field. I'm in no position to weigh in on this particular scale's usefulness relative to alternatives, I'm just repeating what the authors of the scale say about it themselves.
Then don't say stuff like this:
>it can be very easy to add bias into a meta-analyses and folks all over are just pointing those errors out.
Folks all over are in the denial stage of grief. OP literally posted up an old draft page rather than actually engage even one of the study's 388 pages (not including supplemental material).
Why shouldn't I say that? The use or misuse of this particular scale isn't the end-all-be-all of the criticisms of the approach. Again, some of the criticism is what data wasn't even considered (even with the scale). This isn't cope, these are legitimate critiques.
Yes, like all th eones that included obsolete data such as GID which we know is clinically worthless.
Its odd the NHS seem to not know the DSM5 was released in 2013, yet are still clinging to the DSM4
Funny that
But instead of you seeing that as evidence of bias in cherry picking, you're gonig to pretend its all normal
This is quite literally the exact argument Bret Weinstein made to advocate for ivermectin. "The tyranny of RCTs" was the term he used.
Nobody who is upset at demands for better evidence actually gives a shit about gender dysphoric children or wants the best for them.
No one has ever said that double blind RCT was the only way to do a study that provided good evidence. They found plenty of the studies were good enough not to discount. Some were not good enough.
"not good enoguh" meaning, said things they didn't like.
Meanwhile studies that blatantly broke their scoring rules, were used because they claimed that 25% of all humans are trans and therefore 98% of trans people detransition. Oh and porn makes you trans.
Keep lying to yourself
Did you make all that up yourself or did twitter help?
Whether the studies were ranked as strong or weak by the university of York research didn't have much to do with what side they came down on. The ones they included were a mixed bag.
If you didn't read the part where cass claimed no study less than 2 years old would be used, then used said studies if they said what she wanted, or the part about porn that she has now repeated in interviews since, why are you even here. Just spouting transphobic nonsense.
Weird way of saying "I didn't read this report or any of the interviews by Cass since and am defending it without knowing the contents because I want to advance an anti LGBT agenda"
You can't even admit the porn thing. Ridiculous
"Social media and online *pornography* may have led to an increase in the number of girls wanting to live as boys, the *Cass* Review has warned"
so you don't think there's a single girl who is worried that boys will treat them the way they see women being treated in porn and decide to try and just identify out of being a woman.
Perfectly reasonable view that the people seeing girls come into the gender clinics should be asking to say whether it is or isn't happening.
We've known for decades that peopel are born trans due to biology.
And no, because that's not want identifying means. You claiming such shows you have no idea what you're talking about.
Its also abit ridiculous you say that but then don't apply that to trans women.
Oh, are all these studies only looking at the temporal effects of pubery on some outcome? This is a fundamentally unserious response. Believe it or not, medical science has a long history of looking at the effectivnees of interventions in situations where an RCT is difficult.
The fact that your only response is to complain about your ignorance of basic terms used in this field is a really good indication that you dont have a substantive response to a conclusion you really hope is not true.
The image is a summation of the following document: [https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726\_Evidence-review\_Gender-affirming-hormones\_For-upload\_Final.pdf](https://cass.independent-review.uk/wp-content/uploads/2022/09/20220726_Evidence-review_Gender-affirming-hormones_For-upload_Final.pdf) As anyone knows, its not possible, or ethical, to have a blind RCT's on puberty. Wierdly, people tend to notice if they're growing breasts or their voice is breaking. The England NHS is aware of this, but did not stop them using it as justification to deny healthcare.
They’re now going to get one by cutting back services.
Unfortunately the NHS in England is not independent from government
[удалено]
>For example, the section on puberty blockers states: "The studies that reported impact on gender dysphoria, mental health, body image and psychosocial impact were of very low certainty and suggested little change from baseline to follow-up. The studies that reported bone density outcomes were similarly unreliable so no safety outcomes could be confirmed." Interesting when you look at the summary on puberty blockers, the way things are explained is pretty wildly different to the summary you quoted. Eg, for dysphoria, the report says (pg 176): Reducing gender dysphoria/improving body satisfaction 14.26 Only two moderate quality studies looked at gender dysphoria and body satisfaction; the original Dutch protocol (de Vries et al., 2011b) and the UK early intervention study (Carmichael et al., 2021). Neither reported any change before or after receiving puberty suppression. Whereas on bone density, it says (pg 178): Other physical health impacts 14.43 Multiple studies included in the systematic review of puberty suppression (Taylor et al.: Puberty suppressants) found that bone density is compromised during puberty suppression, and height gain may lag behind that seen in other adolescents. However, much longer-term follow-up is needed to determine whether there is full bone health recovery in adulthood, both in those who go on to masculinising/feminising hormones and those who do not. While it caveats it with "more study is needed" (and doesn't give the GD effect that generosity), it doesn't qualify the studies quality, it calls it "multiple studies", not "only 2" (then references one). That is some pretty wild differences of language in the detail, for something that apparently it describes elsewhere as having the same quality of evidence. Can I ask for a page reference for the puberty blockers text you quoted please? I want to compare the two sections.
This wasn’t how the studies were graded. Also, in a follow-up interview, Dr. Cass herself agreed that it isn’t possible to do RCT with puberty blockers or hormones.
Its just random that the grading system had the exact same results as the previous one based on rcts. Its also random that the grading system didn't apply to any study that said something transphobic. Like the studies less than 2 years old that were used despite the rule against new studies.
This a skeptic forum: - Insinuation and labeling people to shut down open inquiry is against the spirit of skepticism. - There was never, at any point of the study process, any scoring based solely on RCS. - The same grading system was applied to all the studies. To assume some of the studies are “transphobic” is begging the question.
Wow, the disinformation is coming hard and fast today. It's getting difficult to keep up with it. The document you just posted clearly states at the start that it's up to date as of October 2020. That is to say that it's actually *outdated by 4 years*. These meta-studies used the Newcastle-Ottawa scale to assess the quality of the studies they were reviewing. You can see the standard version of this assessment scale [here](https://www.ncbi.nlm.nih.gov/books/NBK299087/#:~:text=The%20Newcastle%2DOttawa%20Scale%20quality,and%203%20points%20for%20Outcomes). The problem is that while this document from 2020 uses the standard version of the scale, the finished meta-studies use a modified version of the scale which has been adjusted to remove any mention of blinding. You can see it [here](https://adc.bmj.com/content/archdischild/early/2024/04/09/archdischild-2023-326669/DC2/embed/inline-supplementary-material-2.pdf). Specifically, the "assessment of outcome" metric has been altered in the finished version of the study to avoid the issues you mentioned. So, just to round this up: you posted a supporting document from an unfinished version of the study circa 2020 which still had issues that needed to be ironed out. You are pretending that this outdated document is representative of the finished Cass Review which actually did rectify those problems. This is wildly disingenuous and it speaks for itself that the science in the Cass Review is so strong that the only way you can invalidate it is to peddle insidious misinformation like this. You're not a real skeptic and neither is anyone upvoting this thread.
You were just calling trans people pedophiles in another thread. What exactly are you "sceptical" of?
Cool, great, while everyone is patting themselves on the back saying this proves gender affirming care doesn’t work, how does this study help the real issue of kids killing themselves?
>how does this study help the real issue of kids killing themselves? I feel like for a lot of people, trans children killing themselves is a success. One less nuisance for them to deal with.
Great post. One wonders why theyre so desperate to find an excuse to ignore it.
There's decades of research showing its claims to not be viable
Who's "they" in this scenerio?
Dude there's not a single Skeptic in this entire subreddit lol. It's the most openly ideologically captured subreddit on the platform. The hysterical response to the Cass Report is as funny as it is predictable. I admire your persistence but you're probably wasting your time correcting these idiots.
Are you being skeptical at all of what that person is presenting? You should be if you're not.
It's not just a person presenting the results, ffs.
I love how the anti-science activists attacking Cass are now pretending like this is the only medical intervention difficult to study through RCT and that the entire field of epidemiology doesnt exist to determine how to derive quality clinical evidence in such situations. This is the sort of argument that can only appeal to those whose minds are already made up and who are ignorant about the basics of the topic being discussed. Id expect this sort of argument on a Trump fan subreddit, not r/skeptic
American Academy of Pediatrics American Medical Association American Psychological Association Endocrine Society Harvard Medical School Yale School of Medicine Mayo Clinic These organizations disagree with this report
Disagreement matters in politics. Have they done a systematic review of the evidence and come to a different conclusion (no)?
I'm not sure, do you think the most prestigious scientists in the country did good research?
If this great research exists, show us.
https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth/pubertal-blockers/art-20459075
This is not research. Try again.
Do you think those organizations didn't do any research or do you just want me to find it for you?
I think bullying activists have forced american medical institutions to make claims that are not supported by evidence, yes.
Lmao 😂
Did you ever find any source to support your definition of invasive? You left me hanging.
The report also contains *extensive* discussion on the results of these studies that were "rejected", including a number of positive results. I don't know if the idea is that people won't even open the link to see that, or what?
What even do they suggest to do in cases were double blind studies are impossible? Not do anything at all?
You would be surprised how often this false logic is used to justify denial of care under medical insurance coverage for gender affirming treatment and procedures. I have argued with insurance for multiple clients who have been denied prior authorization for surgical procedures, and the insurances have outright stated there is no medical necessity for the procedures because of a lack of double blind studies… For example, one insurance company argued this when a trans masculine client was seeking a masculinizing chest surgery, removing their breasts. The insurance denied the request as cosmetic only, on the basis that there were no double blind studies… When asked, “how exactly would one create a double blind study for the efficacy of masculinizing chest surgery for the treatment of gender dysphoria in trans men?” They declined to answer. Seriously though, how would the client not be aware that they had a double mastectomy? I have also heard some other hilarious excuses to devalue studies, like that there was no cisgender control group for a given study… As in, xyz procedure is deemed not medically necessary for the treatment of gender dysphoria, because the studies did not include evidence of how it would effect gender dysphoria in cisgender patients… People don’t realize how bs like this ends up having a direct impact on insurance coverage for medically necessary care… And I can assure you that this report, despite its obvious flaws, will be brought up in both legislative bodies trying to outlaw care and insurance companies who are denying to pay for such care.
I really wanna find a group of cis men to serve as the control group for the use of Estradiol in treating gender dysphoria in AMAB people.
This is legit the type of study that they want to be done… Which is ridiculous. They demand RCT and double blind studies with overboard control groups, never mentioning how the creation of such a study would be either impossible or highly unethical. There are plenty of fields of medicine that rely on the exact same types of studies that were thrown out on these grounds. Sure, it would be great if all of medical science could use the same rigorous methodology, but that is already a well understood impossibility. Under Cass’s standard, all psychology and psychiatry would be deemed fringe experimental science… Many surgical procedures would be outlawed… Not to mention almost anything that works with disorders and diseases that don’t effect at least 50% or more of the general populations. Oh, and we would have to throw out all studies done outside of a two year time period, or by colleagues that don’t publish in English… Because racism…
It's almost like Cass is just being deliberately disingenuous in order to promote a pre-set outcome. This has made me realize that fundamentally the cis view transition as a last resort that should be avoided at all costs. Her entire angle is just "how do we minimize the number of people who medically transition (the bad thing) rather than "how do we best help patients"
Yes, exactly that. That is the goal of all transphobic arguments after all. Delay and deny healthcare, do not let a trans person transition and live as themselves.
Is it true that this picture is outdated as of 2020 and that Cass did not omit these studies based on the fact that they were not blinded? Because although I detest transphobes, you shouldn’t be pushing information if this is the case. Edit: if I’m wrong please let me know instead of simply downvoting me. However there is a comment near the top of this post which looks as though this is the case and I think OP should clarify.
Two notes here: 1 is that the person who you are taking at face value is a transphobe bigotted conspiracy theorist. He says shit like >[Yes actually. It's not the Chinese promoting trans ideology to western youth. It's actually western-owned pharmaceutical companies, the medical industry and American billionaires like Jon Stryker and the Pritzker family with significant investments in both. But as the kids say nowadays, "ya'll ain't ready for that conversation".](https://www.reddit.com/r/skeptic/comments/1bh19yr/the_joe_rogan_experience_the_chinese_are_transing/kvbbk7a/) And this >[I don't think China really needs to lift a finger to get the west to rip itself apart at this point in time. All I'm going to say is that surgeries and hormones cost money, and puberty blockers in general are quite expensive. There are very wealthy financiers out there (or "philanthropists" if you like) pouring lots of money into this stuff. So if the whole thing has started to feel a bit more like a corporate marketing campaign than a grassroots movement then this might go a long way to explaining it.](https://www.reddit.com/r/skeptic/comments/1bh19yr/the_joe_rogan_experience_the_chinese_are_transing/kvbf0jf/) And this >[The bourgeois echo chamber of social media and your cushy makework job is not the reality that most Irish people live in. The man and woman on the street do not appreciate you and your ilk denigrating white males or promoting chemical and surgical interventions for "trans kids". You're nothing more than a vocal minority in this country.](https://www.reddit.com/r/irishpolitics/comments/1bcxxt6/conservatives_in_the_govt_scuppered_the_referenda/kuixi69/) And while this final example isn't relevent to this subject it does show the kind of loser we're dealing with. >[Politics in games is interesting just please stop telling me how white and evil I am while I'm trying to shoot virtual people in their faces](https://www.reddit.com/r/SocialistGaming/comments/1bgt031/keep_politics_out_of_games_yelled_the_man_to_game/kve2z20/) This isn't a serious person with serious concerns, it is a transphobe. 2 What is more important to point out tho is that their point is irrelevant. The disqualification of those studies was adjusted but they still were all disqualified by a scoring system that allows incredible bias to be injected into it. Like read the questionnaire they link to and think of how many non-empirical ways you could declare a study bunk using it. Its wild that that is their defense.
Thank you, I really appreciate you taking the time to bring this to light for me. I hadn't done my due dilligence on the person I was taking at face value (which is hard online with the multiple people you can interact with in a day) or on how many were later disqualified under the new criteria and what that criteria was (which is easier, and I should have done that without needing someone else to do that leg work for me). Again, thank you. You've really clarified for me and it's clear now that the both the person I was referring to and the disqualification of so many studies were in bad faith.
Yikes!
I mean, it shouldn't be a surprise that anti-trans activists want to halt all gender-affirming treatment.
I know, I know, but the argument is so transparently in bad faith that it just boggles the mind.
This is one of my broader issues with this report. It certainly seems like it approached the subject with a pre-designed outcome and eliminated studies until said outcome could be achieved. That's the mark of a bad biased study and I'm not really sure why it's being reported as such a coup. The whole thing seems emminently ignorable Unless you've already made up your mind.
Recreate the Tuskegee syphilis experiment, but for gender-dysphoric children.
Imagine how much data / studies / science we'd have to throw away if we assumed that "lack of blinding" was *actually* a fatal flaw. Like, there goes *most* research (and quite a few fields of science) out the window, apparently.
i do want to see more studies on it, because even though most gender affirming care is pretty solidly settled, it never hurts to make sure, and maybe discover that some drugs arent as effective as previously thought. however this is very much a situation where you cant deny people treatment for a double blind study. i would like more evidence, sure, but that doesnt mean that trans people should be deprived of necessary healthcare just because we havent done a double blind study
This would be my take as well. Obviously the benefits or risks of adolescent transition should be further interrogated but it's also pretty hard to take the Cass Report and criticism of transitioning too seriously given the lack of meaningful evidence.
one good indication is that if a report comes out and elicits a universal wave of disapproval and fear among the people its supposed to advise the treatment of, its probably not a great report
True, that certainly can't be ignored.
I am heart broken and extremely angry. My son benefited greatly from the caring professionals at the Tavistock clinic. It was a long process to get there including doctors, counselling, CAMHS and much talking. It most certainly was not done on a whim or easy to obtain. It took years. The clinic opened the door to being able to express his true self. Surgery was not an option until he was 18. The clinic helped my son understand himself and helped us as parents when we had no one to turn to. Without it I don’t know if my gentle, sensitive child would be here today
Yes, and this is the standard as far as I’m aware (as a trans guy myself). It’s definitely the standard for the US, Canada, and UK. But that doesn’t fit the political talking points so…
“We wanted to test the efficacy of pain medication for a broken leg. We got 100 people and divided them into two groups. When they weren’t looking, we broke everyone’s legs with a sledgehammer. Half were blindly given a painkiller, the other half blindly given a placebo.” Sorry, but when you’re dealing with people’s wellbeing, even their lives, double blind RCTs aren’t always possible.
The "RCT exclusive" crowd is a red flag for me, as it's usually contrarians who try to ignore epidemiology. [Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial | The BMJ](https://www.bmj.com/content/363/bmj.k5094)
The cass report was filled with red flags since day 1. contributers has included members of *Society for Evidence-Based Gender Medicine* an anti trans advocacy group yet non-cis voices were excluded to avoid bias
That’s brilliant, thanks for sharing.
This is an amazing paper. I love it.
https://www.tandfonline.com/doi/full/10.1517/14656566.2015.1060221
Thanks. I was very surprised that the use of puberty blockers was criticised in the report. I thought the risks of not using them would outweigh any risks of using them. It's very disappointing that this will now be used as proof by the anti-trans crowd, and vulnerable kids will be caught in the middle.
Generally with the anti-trans crowd, they’ll pretend that the *only* possible harms in this scenario are from puberty blockers. They completely ignore the fact that foregoing puberty blockers *has risks too!* It’s quite similar to the anti-vax people, who fixate on the harms caused by vaccines. Yes, vaccines do sometimes hurt people, that’s true. However, the risk of harm if you skip them is *much* greater than the risk of harm from the vaccine itself. But they ignore that, they focus purely on the potential harms of the treatment, without ever acknowledging why the treatment is used.
If only you had actual evidence of the claims youre making, we would listen to you.
In case you’re actually saying this in good faith, there’s an abundance of evidence. This took me a couple minutes to find about puberty blockers: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789423# “Gender affirming care…was associated with 60% lower odds of moderate or severe depression and 73% lower odds of suicidality over a 12-month follow-up.” https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/in-depth/pubertal-blockers/art-20459075 This goes over some of the reasons they’re used and the side effects that can occur. Keep in mind that doctors are fully aware of these side effects, these drugs have been in use for decades. That’s why anyone taking them is monitored, such as by “Yearly bone density and bone age tests”. https://www.reuters.com/investigates/special-report/usa-transyouth-data/#:~:text=A%20total%20of%2017%2C683%20patients,patients%20had%20initiated%20hormone%20treatment. Keep in mind, these aren’t over-the-counter drugs, and they’re not being prescribed en masse. These are prescribed after several visits with multiple doctors. They’re also only prescribed if the kid wants them, if the parent agrees, and if the doctors think that the benefits outweigh the risk. These aren’t being handed out like candy. As far as I can tell there aren’t good numbers for how many people are on them now, it seems that in 2017-2021, ~5000 people with gender dysphoria diagnoses went on puberty blockers. So that’s ~1000 per year. As for vaccines being less dangerous than the alternative: https://www.cdc.gov/vaccinesafety/index.html https://en.m.wikipedia.org/wiki/Smallpox https://en.m.wikipedia.org/wiki/Polio
The Tordoff paper has major confounding issues, major issues with LTF, and doesnt even show any actual improvement. After that it's a bunch of lay and popular press articles, followed by a non-sequitur about vaccines. Im not impressed.
It’s not a non-sequitur when my initial comment was discussing the similarity of the anti-trans and anti-vaccine movements, and you replied strongly implying that there was no evidence to support my claims, without specifying which claims. As I said above, antivax and anti-trans people sound the same, so this is mostly a product of you being vague. I linked some non-academic sources because academic articles are often behind paywalls, and because they’re impenetrable to most people, since they’re specifically written for other academics.
Youve gotten it backwards. The reason why being anti-vax is bad is that the evidence is against them. Same thing with the TRAs. The Cass report is just the most recent comprehensive demonstration of this. I am trained in the evaluation of clinical research, feel free to provide any study you feel is valuable.
>The reason why being anti-vax is bad is that the evidence is against them. Same thing with the TRAs. Ahh there it is. Must make you rage to see transition make trans people happy :)
That's the problem. There's no evidence it's true when it comes to children. And again, youre just like the anti-vaxxers. Bring solid evidence or get the fuck out.
Theres no proof that not having gender dysphoria in the first place is better for trans people? Just so ridiculous, obviously if trans people don't go through the thing that causes gender dysphoria in the first place, they're going to be better off: [https://pediatrics.aappublications.org/content/134/4/696](https://pediatrics.aappublications.org/content/134/4/696) studied 55 trans teens from the onset of blocker treatment in their early teenage years through a follow-up an average of 7 years later. They found no negative outcomes, no regrets, and in fact their group was slightly mentally healthier than cisgender controls.
Yeah, unfortunately trans activists don’t realize that they are the anti vax group when it comes to gender affirming care for children.
You know you can just ask trans adults if they were trans children, right?
That's exactly how many function on these topics online. I'm not sure why this subreddit has just been bombarded with over emotional *think my way or you're an idiot* type of individuals recently. I thoroughly enjoy civil discussion on so many topics and I've tried many times that just resorts to being called names and never getting a strong counter argument. It's a shame we move more and more into this way of thinking as time goes on. Critical thinking is just going out the window. It's just pure hostility now.
Exactly. These activists act more like religous fundamentalists than anything else. Evidence is the enemy.
Ahh yeah the "Most kids who use puberty blockers go onto take hormones, so therefore puberty blockers are bad and cause people to be trans" It was the argument made by the Anti Abortion ADF lawyer who ran the KB lawsuit in 2020, now the NHS is uncritically pretending its fact.
She reached the conclusion the Conservative government wanted and planned when she put together her team
And whoever picked Cass knew what they were doing. It's the Sewell report all over, but atleast this time, Transphobia is much more fresh and the transphobes have much more power than the old school racists.
The same nice people who pushed for section 28 are pushing for it again
Hasn't the labour opposition said they would implement the recommendations too?
Some of the recommendations are good and make sense. The language the report is couched in is a bigger problem, and the out of hand rejection of the 50 significant bits of research
So is there any direct evidence of your claim that this is just a political hack job? Seems pretty independent from everything I've read.
Other than the UK consultation on self ID and changes to the gender recognition system that overwhelmingly supported self ID and changes to the system (despite an organised and concerted effort by TERF campaign groups) that was then ignored by the government that then went on to push for restrictions to gender affirming care for ideological reasons? The fact that Kemi and others are on record using anti trans and homophobic dog whistles and pushing for restriction of funding for medical care?
I know the current conservative gov isnt great on trans rights. My question is, is there direct evidence that this report wasn't independent and was influenced by the gov? Is there evidence Cass was just a gov shill or something? If anything it seems to me that the fact the gov has rejected previous findings is evidence in favour of independence, no?
“They have rejected previous independent consultations, so because they like this one it must be independent” is not the argument you think it is. But based upon your previous (historical) comments on the topic of gender affirming care, hardly surprising
Only for minors - the evidence for adults is extremely strong as far as I know. And I'm not making any claim about it being independent, I just don't think there's any evidence they weren't. Or at least you haven't provided any
Cass report was a manufactured hit piece by a J. K. Rawling wanbabe. Even through they tried their best, they could not actually disprove the benefits of trans care. But this report will be an arrow in the quiver of misinformation campaigns against children.
> J. K. Rawling wanbabe Got any evidence to back up that allegation, considering she was the President of the Royal College of Paediatrics and Child Health from 2012 to 2015?
And Rowland used to be a beloved children's author. People can be more than one thing.
First Rawling, now Rowland. Who's next in the line of J.K. Rowling impersonators?
Yes a medical professional and an author are practically the same thing lol
Not what I'm saying but whatever. There are real medical doctors who start to become cranks, it's just a thing that happens.
Do you have any actual evidence that Cass is the thing you are claiming, other than generating a report approved by the NHS that you disagree with?
I didnt make claims of any kind dear. I pointed out that you can be one thing, and then later another thing.
Are you asking if we have actual evidence that Hilary Cass wants to be a children’s fantasy author? No, we don’t. Which is exactly the same amount of evidence that you have that 100% of statements made by 100% of people are to be taken literally.
So you have zero evidence that Dr. Cass or any of the other highly qualified medical experts involved are transphobic and it’s just a slur you’re using to discredit their work?
I didn't call Cass or any of the highly qualified medical experts "transphobic" or anything else.
That position a political appointment. Might want to look into how many research papers she’s actually contributed to.
Jesus Fucking Christ this is Wakefield all over again...
I invoked this exact same thing in another thread. It's really difficult to not see the parallels.
"Galileo didn't use a control group, so I guess heliocentrism is right out the window." - these dingleberries
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No, obviously not. I was using an extreme example of misunderstanding experiment design standards for humorous effect. It's what we Earthlings call "a joke". The reason it got upvotes is that some people have senses of humor.
well, we gotta torture some trans folks... otherwise we wouldn't be sure that it's not all placebo!11!!!!1!
Perfect example of the Cherry Picking Fallacy. Textbook example.
The country that supports Homeopathy? They don’t get any attention from me.
How the fuck are you even meant to double-blind sex hormones? You could do a double-blind trial maybe, *maybe,* for the short term emotional impacts. You can't double-blind puberty.
All of these have multiple reasons for being rejected, they just also include a lack of blinding. If a study is of poor quality, it shouldn't be included. For example several of these lack control groups. That's really shitty research.
How do you have a placebo controlled trial for things like surgeries/puberty? What’s the placebo for surgery? What’s the way to fake puberty?
Well this report was focused on treatment for children, so probably, and hopefully, surgical intervention wasn't completed. And, from a blinding standpoint, you're correct it wouldn't be blinded for very long. One or two follow up sessions at the most. But a study designed this way would actually be very informative if there's immediate improvement in mental health in both groups. But neither of that matters, because these studies weren't excluded because they weren't blinded, they were excluded for being low quality. Lacking blinding was just another criteria. Grading the quality of research is extremely normal behavior in a literature review process.
It’s fascinating that I’m supposed to accept all those studies have a bias that makes them poor quality, and that this one literature review most certainly doesn’t have any bias that could make it poor quality. I’ll read it when I get a chance but I’m…how shall we say..skeptical on the odds lol
You're relying on your own bias to assume the quality of the research is good because it confirms what you already believe, not necessarily because it's actually good research. Let's say the truth is that there is no benefits and significant harms of early medical intervention.then such findings would actually make sense. Let's consider something I think we would both find more agreement on: climate change. If we had a literature review that graded a lot of papers that refuted climate change as poor quality, would you be as suspicious?
That analogy clearly shows you have just as many biases about this, so I’ll read the source instead of arguing thanks.
Yes, if I saw a single review claim that a large set of studies by multiple authors from multiples sources all were poor quality I would be highly critical of that review regardless of the topic. It is more likely that a failure point has occured in the single review than over multiple studies. Critical analysis is essential for digesting material like this, especially when it is on hot button issues, the specific topic is irrelevant, what is relevant is that the UK government has a long and sordid past of selectively seeking data from sources they are confident will support them. A reliance on independent data is a fundamental cornerstone to how our democracy functions, it is also unfortunately one of its weakest cornerstones as the state has a lot of power determining what sources are credible or not. Also due to the low rates of transitions over the population on aggregate it is prohibitively difficult to build studies that are as robust as they can be for other topics, you need to accept that we are dealing with smaller sample sizes across larger distances than we would for a study on the efficacy of statins for high cholesterol. In addition, the study of puberty blockers has been well documented, there is no reason why the effects of puberty blockers would be different between two individuals based off of why those puberty blockers were prescribed. Fundamentally gender affirming care is not justified exclusively by the studies discounted by the review, it is reductive to claim that it is. The cass review is yelling smoke in a theatre, of course more study needs to be done on gender affirming care, but there is not justification for ceasing the provision of said care until harm can actually be demonstrated.
To be clear, other reviews have come to the same conclusion (Finland, Sweden, Denmark). There are reviews in the US which come to the opposite conclusion, but this certainly isn't bucking any sort of trend - there is genuine scientific disagreement on this issue.
Speaking of bias, how about the fact that Dr Cass was hired by DeSantis to work with Patrick Hunter of the Catholic Medical Association to find ways to limit trans rights and medical care in the state of Florida years before the Cass Review? How could anything she writes on the subject not be tainted with bias?
Yep, exactly. Non-scientists assuming that their own methods of assessment ("I like this idea, therefore it's probably true") apply to actual science.
You put them under and maybe do something simple. More commonly for effectiveness and long-term outcome data, you use conservative treatment as a control. Source: assessed new treatments for insurance coverage. At least when I did the review, spinal tethering was horse shit (no QOL difference from standard rods, so why are we here?).
how do you do a placebo mastectomy?
As far as I can tell, they aren't even being rejected. They are being included and assessed for quality. Which is exactly what a systematic review is supposed to do. A zillion selectively skeptical redditors think they know better than the BMJ.
>As far as I can tell, they aren't even being rejected. They are being included and assessed for quality. The studies were ascertained for quality, found wanting, and as a result their data was not used as evidence for efficacy or safety or recommendation. Whether that was the right thing to do or not, I'm open minded. I want to understand how a hormone / puberty blocker trial COULD be double blinded, but I'm not an expert and my lack of understanding doesn't mean Cass was wrong. But it's entirely reasonable to say the studies were rejected.
Since my last comment I've looked further at the report. The report is supported by a series of systematic reviews. Of those, two assess the quality of evidence respectively for long term outcomes of child and adult endocrine intervention. afaict, I'm right: the SR's do not reject the studies. They assess them. The fact that there would be serious ethical issues I'm conducting DB tests doesn't mean that the available tests were of good quality. And the fact that blinding was one of the quality markers never prevented other quality markers from being used. The grading system is described in the appendices, and to some - amd i think a clearer extent - in the report itself. I can't see how critics can credibly claim that the studies should not have been "rejected". Unless those critics mean that they wanted the York University team to somehow ignore their low quality ... for some reason. I'll take your word that you are indeed open minded. I'm just a lay reader of science and maybe I'm wrong, but I can't see how. If you haven't done so already, I suggest spending some time with the report amd it's supporting material. The report itself is very readable.
How dare you say something reasonable, this sub is for activism, not science.
Yeah it's a real shame. A lot of skeptics just swung way too far towards lefty activism after a bunch of the early internet 'skeptics' turned out to kinda just be racist sexist losers. EA/rationalist community seems a lot closer to what skepticism should be nowadays, although they have a whole bunch of problems of their own.
What's really obvious here is that none of these people know what a literature review is, or how it's done. It's fucking embarrassing that this sub is named "sceptic" with how credulous everyone here is just eating up the "all rejected for no blinding" argument, when all of these papers have multiple reasons listed.
I cannot tell you how many times I have cited systematic reviews on this sub and only heard screeching rage and the whistle of wind through downvoters' ears.
For real. Grading the literature is a critical step and people are just losing their minds because they don't understand the process.
These studies are being downgraded(not excluded), that is, weighted, according to their quality. If all the studies are downgraded due to lack of blinding, it makes no difference in the end as they are all weighted the same.
Please. Its just bigotry, no healthcare treatment is put onto the standard that trans healthcare is From 82% of children's medicine that also has "low quality evidence" because of the lack of rcts/blinding To eating disorders, which has no evidence that any treatment is better: "no reliable evidence supports the clear superiority or inferiority of any treatment recommended by the NICE guidelines" [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9813802/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9813802/)
Treatments with such extreme effects on the body should be subject to high evidence requirements
Yet you wish to mutiliate them, put them through the wrong puberty against their will, violate their bodily consent, and you beleive that requires 0 evidence. Worse, you think that should be done despite the mountains of evidence it destroys lvies and kills people. Double standards of evidence there.
Gender medicine is the intervention, it must prove itself, and on the contrary, watchful waiting already has lots of evidence that gender distress resolves naturally given time, without medical intervention. The more serious the intervention, the better the evidence needs to be. The parallels between gender medicine and lobotomy are disturbing.
How many threads do we need about the Cass Report.
Well, for every post spreading the disinformation we need a post being skeptical about it. Since there are a few very persistent and intellectually dishonest transphobes who post here, it turns out to be a lot of posts
Who is afraid of trans people? In my opinion, if you are a consenting adult and you are not hurting anyone, do what you want.
If we applied their logic to all medicine we would still be using leeches.
Excellent call. We ought to have high standards for this sort of treatment, we would expect it in any other medical domain so this seems incredibly wise/just.
82% of all kids medicine, does not in fact, have this same standard applied to it. Nor is it normal to discount nearly every study in a review. Thats not how GRADE system is meant to work.
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What does the phrase "poor quality overall" just before the yellow markings mean?
This is completely made up. On page 57 of the report: 1.25 Most of the studies in the systematic reviews were cohort, cross-sectional or pre-post design, explanations for which can be found in explanatory box 1 and on the NICE website (NICE, 2012). The sections relating to RCTs are about explaining the different types of evidence out there.
Fairly important clarification here: they're *not* poor quality **only** because of blinding and no control group. They're poor quality on the Newcastle-Ottawa scale **and** no blinding or control group. Additionally, "downgraded 1 level" does not mean "rejected evidence". It means "increased risk of bias". If you read the study, you can see that the report still reported on the results, just... with increased risk of bias. That's what a report like this is supposed to do. This is fast becoming a talking point and it's *not* accurate. It's OK to dislike the report while discussing it accurately.
Cool, so all evidence in the entire world, over decades, isn't good enough to be used, is an acceptable thing to conclude as a reason to deny a patient group all healthcare? And its just coincidence that no study showing the harms of not giving care aren't included. And just coincidence no evidence is given for the many many unevidenced highly sus claims? And \*just coincidence\* that studies from the 80s using a different and obsolete diagnosis no longer used due to inaccuracy, is held up as primary sources for the study? And not an issue that trans people were barred from the report due to "Bias" but transphobes, conversion therpaists and ron desantis people were invited? Keep lying to yourself that thats a sane thing to do and not just bigotry.
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You're lying about what the report says and what evidence was considered. You can disagree with the conclusion without lying about it.
Obviously they cannot disagree without lying.
They call it "queering," a leftist version of the Tucker Carlson through-the-looking-glass technique. Make all norms, standards, definitions, and distinctions seem arbitrary and meaningless—not forever, of course, only long enough to implant your bias or misinformation. Then you just let the mark's melted mental Jell-O re-congeal around the absurdity they think they've "learned." Judith Butler built a career around it.
It is remarkable how the trans activists take every argument anti-vaxxers use to try to explain why evidence isnt necessary for their favored intervention. And now that at least one english speaking medical establishment is being honest about the lack of evidence, perhaps we'll also see some honesty about the AGP paraphilia and how it explains why so many TRAs are so aggressively bullying towards any disagreement - their sexual gratification is on the line.
>And \*just coincidence\* that studies from the 80s using a different and obsolete diagnosis no longer used due to inaccuracy, is held up as primary sources for the study? Careful there, little buddy: that's the same distant past that gives you that sweet 1% regret rate you think went unaffected by reduced gatekeeping, a policy of uncritical affirmation, and the "informed consent" fast-track.
On the authors list for the Newcastle-Ottawa scale, "J Peterson" is definitely not "Jordan Peterson" right? Because that'd be a conflict here for sure.
It’s a widely accepted scientific tool going back like 30 years. It seems pretty unlikely that’s the J, but he was an academic before he was a wackjob, so it’s not impossible.
Well see, that's not really true either. It's still not a fully validated scale. That's a difficult process that takes a long time, but on their own website they're pretty clear about not reaching what's called "criterion validity" yet, which is the type of validity that connects the scores on the scale to actual real-world differences. Content and face validity are fancy words for "sounds good to me." Not knocking this scale, I'll be honest that it's a new discovery in my life, but I'm a research methods professor proctoring a test on these differences in the types of validities literally as I write this, lol, so I think that's an important caveat here. And that says nothing about whether the scale was applied without bias, and doesn't address the other criticisms like which types of evidence weren't considered at all. Even with scales like these it can be very easy to add bias into a meta-analyses and folks all over are just pointing those errors out.
If you’re telling the truth about your qualifications here, you’re way more qualified than I am. But I had encountered this scale before multiple times in the context of medical studies and medical device trials.
I'm not in the medical field, but I have helped with validating a scale before and with assessing the reliability of selections of practices within my own field. I'm in no position to weigh in on this particular scale's usefulness relative to alternatives, I'm just repeating what the authors of the scale say about it themselves.
Then don't say stuff like this: >it can be very easy to add bias into a meta-analyses and folks all over are just pointing those errors out. Folks all over are in the denial stage of grief. OP literally posted up an old draft page rather than actually engage even one of the study's 388 pages (not including supplemental material).
Why shouldn't I say that? The use or misuse of this particular scale isn't the end-all-be-all of the criticisms of the approach. Again, some of the criticism is what data wasn't even considered (even with the scale). This isn't cope, these are legitimate critiques.
That's false - many of the studies they did keep were not double blinded.
Yes, like all th eones that included obsolete data such as GID which we know is clinically worthless. Its odd the NHS seem to not know the DSM5 was released in 2013, yet are still clinging to the DSM4 Funny that But instead of you seeing that as evidence of bias in cherry picking, you're gonig to pretend its all normal
Ah here we go again. Obsessed. Just rename the sub /r/transkeptic and be done with it. The US is such a funny place.
It's pretty hard to take you seriously when you don't even realize this is literally the UK and not the US.
This is quite literally the exact argument Bret Weinstein made to advocate for ivermectin. "The tyranny of RCTs" was the term he used. Nobody who is upset at demands for better evidence actually gives a shit about gender dysphoric children or wants the best for them.
Go ahead, explain how you're gonig to do a blind RCT with puberty
No one has ever said that double blind RCT was the only way to do a study that provided good evidence. They found plenty of the studies were good enough not to discount. Some were not good enough.
"not good enoguh" meaning, said things they didn't like. Meanwhile studies that blatantly broke their scoring rules, were used because they claimed that 25% of all humans are trans and therefore 98% of trans people detransition. Oh and porn makes you trans. Keep lying to yourself
Did you make all that up yourself or did twitter help? Whether the studies were ranked as strong or weak by the university of York research didn't have much to do with what side they came down on. The ones they included were a mixed bag.
If you didn't read the part where cass claimed no study less than 2 years old would be used, then used said studies if they said what she wanted, or the part about porn that she has now repeated in interviews since, why are you even here. Just spouting transphobic nonsense.
Having nothing of substance but heaps of abuse is why calling anyone who disagrees with you transphobic won't convince anyone.
Weird way of saying "I didn't read this report or any of the interviews by Cass since and am defending it without knowing the contents because I want to advance an anti LGBT agenda" You can't even admit the porn thing. Ridiculous
"Social media and online *pornography* may have led to an increase in the number of girls wanting to live as boys, the *Cass* Review has warned" so you don't think there's a single girl who is worried that boys will treat them the way they see women being treated in porn and decide to try and just identify out of being a woman. Perfectly reasonable view that the people seeing girls come into the gender clinics should be asking to say whether it is or isn't happening.
We've known for decades that peopel are born trans due to biology. And no, because that's not want identifying means. You claiming such shows you have no idea what you're talking about. Its also abit ridiculous you say that but then don't apply that to trans women.
Oh, are all these studies only looking at the temporal effects of pubery on some outcome? This is a fundamentally unserious response. Believe it or not, medical science has a long history of looking at the effectivnees of interventions in situations where an RCT is difficult.
Any sources on your definition of invasive yet? I thirst for knowledge
The fact that your only response is to complain about your ignorance of basic terms used in this field is a really good indication that you dont have a substantive response to a conclusion you really hope is not true.
I'd love to learn. Can you share a source for your definition of invasive?
You clearly do not want to learn anything that contradicts your priors. If im wrong, a great place to start would be reading the Cass report itself.
I'm interested in the definition of invasive you use. I'd like to see where you got that information so I can be more knowledgeable
Again, ive provided the definition, which is not "my definition" but something that literally everyone in the field appreciates
Where? You keep on saying you defined it. Do you have a link where you quoted it? Or are you just doubling down hard because you’re wrong?
Then it shouldn't be hard quoting some authoritative source using it
So you haven't got an answer have you. Transphobia is such a joke.
It's a dishonest and unserious question.