Has the UK's NHS changed it's approach to care for trans youth?

[icehorse]

I read this article and the related document several times. I might have gotten this wrong, but here's an excerpt from the article:

We are now going out to targeted stakeholder testing on an interim clinical commissioning policy proposing that, outside of a research setting, puberty suppressing hormones should not be routinely commissioned for children and adolescents who have gender incongruence/dysphoria.

To summarize the findings of a study conducted by NHS England:

1 - There was a 2,000% increase in trans-related referrals in the last decade.
2 - There is a marked, poorly understood change in the types of patients being referred.
3 - Thee is scarce and inconclusive international evidence to support clinical decision making.

NHS commissioning » Implementing advice from the Cass Review

 

[exchemist]

I read this article and the related document several times. I might have gotten this wrong, but here's an excerpt from the article:



To summarize the findings of a study conducted by NHS England:

1 - There was a 2,000% increase in trans-related referrals in the last decade.
2 - There is a marked, poorly understood change in the types of patients being referred.
3 - Thee is scarce and inconclusive international evidence to support clinical decision making.

NHS commissioning » Implementing advice from the Cass Review

I really couldn't care less.

 

[Debater Slayer]

I read this article and the related document several times. I might have gotten this wrong, but here's an excerpt from the article:



To summarize the findings of a study conducted by NHS England:

1 - There was a 2,000% increase in trans-related referrals in the last decade.
2 - There is a marked, poorly understood change in the types of patients being referred.
3 - Thee is scarce and inconclusive international evidence to support clinical decision making.

NHS commissioning » Implementing advice from the Cass Review

The report says puberty-suppressing hormones shouldn't be routinely commissioned to children and adolescents. This is nothing new: the NHS currently states the following on its website (highlighting mine):

• a referral to a specialist hormone (endocrine) clinic for hormone blockers for children who meet strict criteria (at puberty)

Gender dysphoria - Treatment

Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary.

www.nhs.uk

It's not news that some treatments for gender dysphoria—and many other conditions—are still being researched and continually improved per the most updated evidence. It's also not news to anyone who understands the basic fundamentals of science that such peer review is a core part of research.

 

[Debater Slayer]

I really couldn't care less.

I can't wait for the current fixation on trans people in some media outlets and parts of social media to blow over. It's unfortunate to see the same five arguments and unevidenced claims being repeated for all sorts of ideological reasons, especially when a subset of people talk about these issues as if they were some political game when said issues affect many trans people's lives.

 

[icehorse]

I can't wait for the current fixation on trans people in some media outlets and parts of social media to blow over. It's unfortunate to see the same five arguments and unevidenced claims being repeated for all sorts of ideological reasons, especially when a subset of people talk about these issues as if they were some political game when said issues affect many trans people's lives.

In your opinion, is it only the critics who are guilty of promoting an ideology?

And relatedly:

ideology: a system of ideas and ideals, especially one which forms the basis of economic or political theory and policy.

Is ideology always bad?

 

[Debater Slayer]

In your opinion, is it only the critics who are guilty of promoting an ideology?

Anyone who rejects science or medical consensus in favor of personal beliefs and preferences and wants to impose their rejection on others is guilty of promoting an ideology. It just happens that most who reject the medical consensus on trans issues and want to base legislation around that stance are among the anti-trans crowd.

And relatedly:



Is ideology always bad?

Not always, but it is bad when it impedes medical understanding or denies a group of people access to professional care.

 

[SomeRandom]

I read this article and the related document several times. I might have gotten this wrong, but here's an excerpt from the article:



To summarize the findings of a study conducted by NHS England:

1 - There was a 2,000% increase in trans-related referrals in the last decade.
2 - There is a marked, poorly understood change in the types of patients being referred.
3 - Thee is scarce and inconclusive international evidence to support clinical decision making.

NHS commissioning » Implementing advice from the Cass Review

I mean, the study of the trans phenomenon (for lack of a better phrase) is relatively young in medicine. Despite the phenomenon being as old as human culture.
Weird but whatever, I guess.
It will be an ongoing learning process for medical science. But that’s just how medicine works.

There was inroads made back in like the 30s but the Nazis burned all that so science had to go back to the drawing board.

(No seriously. That actually happened.)

Holocaust Memorial Day Trust | 6 May 1933: Looting of the Institute of Sexology

On 6 May 1933, the Institute of Sexology, an academic foundation devoted to sexological research and the advocacy of homosexual rights, was broken into and occupied by Nazi-supporting youth. Several days later the entire contents of the library were removed and burned.

www.hmd.org.uk

Given that, I mean, medical science is not doing too badly in its current understanding and application

 

[icehorse]

I mean, the study of the trans phenomenon (for lack of a better phrase) is relatively young in medicine. Despite the phenomenon being as old as human culture.
Weird but whatever, I guess.
It will be an ongoing learning process for medical science. But that’s just how medicine works.

Mostly agreed.

Given that, I mean, medical science is not doing too badly in its current understanding and application

But is it not doing too badly?

Call me old fashioned, but I think "first, do no harm" is still a pretty good principle in medicine.

The AJP (American Journal of Psychiatry), has recently published a large study that concludes:

When gender dysphoric patients who received surgeries were compared to those who did not have surgeries, there was no statistically significant difference in their mental health utilization.

So from this study it would be reasonable to say that these surgeries were not helpful, correct?

Correction of a Key Study: No Evidence of “Gender-Affirming” Surgeries Improving Mental Health

 

[SomeRandom]

Mostly agreed.

But is it not doing too badly?

Call me old fashioned, but I think "first, do no harm" is still a pretty good principle in medicine.

The AJP (American Journal of Psychiatry), has recently published a large study that concludes:



So from this study it would be reasonable to say that these surgeries were not helpful, correct?

Correction of a Key Study: No Evidence of “Gender-Affirming” Surgeries Improving Mental Health

If I understand your link correctly (and I make no claims of doing so thoroughly) it seems that the organisation in question asked for a more unbiased examination of a peer reviewed analysis. Which is fair enough. That’s just science.

The conclusions still seem a bit fuzzy to me, though that may be down to my lack of formal education on the subject.
It seems to suggest that the fewer mental health visits were originally interpretated as a net positive or overall reduction in detrimental mental health. Something that was challenged and addressed. This is not really the same as concluding that the opposite is true though. Not necessarily, anyway.
Though this organisation did so. Presumably with their own studies to back that up. I think?

But again, I lack the formal training of a scientist. So I’m probably not the best person to ask to interpret scientific research and reviews, admittedly

Edit. I have since googled the group, since the language on their website seemed a bit, well not scientific. If that makes sense?

It seems they are apparently a known anti trans group not affiliated with or even recognised by the wider medical community as valid. It is also apparently known for pushing disinformation, conversion therapy for sexual orientation (?!!!) among other activities. Most of them political in nature.
Just thought you should know

Society for Evidence-Based Gender Medicine - Wikipedia

en.m.wikipedia.org

 

[icehorse]

It seems they are apparently a known anti trans group not affiliated with or even recognised by the wider medical community as valid. It is also apparently known for pushing disinformation, conversion therapy for sexual orientation (?!!!) among other activities. Most of them political in nature.
Just thought you should know

I think that a more accurate to say that SEGM often opposes the current "standards of care" for trans people, while promoting the general idea of such healthcare. But what's important here is that they're quoting the AJP, which presumably represents mainstream psychiatry, correct?

(sorry for the late edit)

 

[Koldo]

Mostly agreed.

But is it not doing too badly?

Call me old fashioned, but I think "first, do no harm" is still a pretty good principle in medicine.

The AJP (American Journal of Psychiatry), has recently published a large study that concludes:



So from this study it would be reasonable to say that these surgeries were not helpful, correct?

Correction of a Key Study: No Evidence of “Gender-Affirming” Surgeries Improving Mental Health

I have merely read your link without reading the actual study. So bear with me. One thing that stands out to me is that they were trying to see what is the link between the use of surgery (and medication) and mental health, right?

But this sounds like the wrong way to approach this situation in my perspective. Here's why: If the distress is being caused by a mental and physical mismatch, what needs to be taken into consideration is the outcome (or at least how the patient perceives themselves) of the surgery/medication.

What if, for example, the surgeries the person in question has undergone weren't sufficient to make them to look like the other sex?

 

[icehorse]

But this sounds like the wrong way to approach this situation in my perspective. Here's why: If the distress is being caused by a mental and physical mismatch, what needs to be taken into consideration is the outcome (or at least how the patient perceives themselves) of the surgery/medication.

So if you were to look at this situation with fresh eyes, how would you characterize a mental / physical mismatch?

What if, for example, the surgeries the person in question has undergone weren't sufficient to make them to look like the other sex?

Yikes ?! You know these surgeries are already extremely invasive and severe, correct?

 

[Koldo]

So if you were to look at this situation with fresh eyes, how would you characterize a mental / physical mismatch?

I don't understand your question.

Yikes ?! You know these surgeries are already extremely invasive and severe, correct?

Sure... So?

 

[SomeRandom]

Well that's partly true. I suppose you could say that SEQM is anti-trans. But what's important here is that they're quoting the AJP, which presumably represents mainstream psychiatry, correct?

I would be wary of really any organisation that is anti anything quoting someone in a respected field. Doesn’t matter the topic.
I mean, for example, it wasn’t that uncommon for homophobic entities to directly quote (and yes misquote) respected medical organisations in order to give credence to rather “iffy” ideas. Ideas often rejected by mainstream medicine in the first place, when examined a bit further.
It’s a well known rhetorical tactic, one implemented in politics in a variety of fields.

It’s better to get the quote straight from the horse’s mouth, so to speak.
Though I admit I’d have just as much trouble accurately interpreting it lol
I’m just being cautious, I guess.
Organisations well known to oppose certain things have a very bad habit of intentionally misinterpreting scientific data. Usually relying on the lack of formal qualifications us laymen have in order to give ideas credence they wouldn’t have otherwise in the field.
Ya know?

 

[icehorse]

Anyone who rejects science or medical consensus in favor of personal beliefs and preferences and wants to impose their rejection on others is guilty of promoting an ideology. It just happens that most who reject the medical consensus on trans issues and want to base legislation around that stance are among the anti-trans crowd.



Not always, but it is bad when it impedes medical understanding or denies a group of people access to professional care.

And the spin just keeps coming..

 

[icehorse]

I would be wary of really any organisation that is anti anything quoting someone in a respected field. Doesn’t matter the topic.
I mean, for example, it wasn’t that uncommon for homophobic entities to directly quote (and yes misquote) respected medical organisations in order to give credence to rather “iffy” ideas. Ideas often rejected by mainstream medicine in the first place, when examined a bit further.
It’s a well known rhetorical tactic, one implemented in politics in a variety of fields.

It’s better to get the quote straight from the horse’s mouth, so to speak.
Though I admit I’d have just as much trouble accurately interpreting it lol
I’m just being cautious, I guess.
Organisations well known to oppose certain things have a very bad habit of intentionally misinterpreting scientific data. Usually relying on the lack of formal qualifications us laymen have in order to give ideas credence they wouldn’t have otherwise in the field.
Ya know?

From the AJP:

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

 

[Debater Slayer]

And the spin just keeps coming..

I don't see any spin in pointing out that certain positions are more likely to impede access to necessary medical care than others. The link in the OP is an example of how medical research is continually improved via peer review and evidence, which only reinforces that expert consensus is much more reliable for medical guidance than ideologically or politically charged opinions (e.g., some politicians' support for banning gender-affirming care for minors).

The NHS currently doesn't recommend "routinely commissioning" puberty-suppressing hormones to minors either, which I pointed out earlier, so I'm also not sure what you were inferring from the excerpt in the OP.

 

[SomeRandom]

From the AJP:

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

Thank you.

Again I’m the wrong person to ask, I just defer to the experts.
Ask me about nerd stuff and I’m your person but science tends to fly over my noggin lol

It seems that the original study was “over enthusiastic” about its reporting of overall improvements to mental health following gender affirming surgery. Apparently due to interpretating fewer visits to mental health professionals signalling overall improvement. An error, to be sure. But scientists are humans too so

Now this doesn’t necessarily demonstrate that the opposite is true, I don’t think that’s how such findings work in the scientific fields.
(Again I’m just a layman so maybe don’t take that as gospel lol. That’s just my understanding of it.)
So it would be equally “over enthusiastic” to take this reassessment as giving credence to the idea that surgery offers a detrimental effect. Or even just a “break even” effect, so to speak.
It’s more along the lines of, more research is needed. Which is kind of standard really.

It is still early days and constantly reevaluating results is just par for the course in all of medicine.
I mean they’re still doing that for cancer treatments to this day. We will hit snags, we will make mistakes and some people may even regret their transition.
That does not mean we should block any access. Certainly be strict about criteria
We should constantly reevaluate and tweak as needed and above all work with the medical establishment to figure out the best courses of actions to take in any given scenario.

(I actually don’t support transition surgery for minors. Just for the record
I know similar surgeries are conducted in various intersex scenarios, due to too much interference with potential puberty outcomes, among other medical reasons. And okay, fair enough. But I do think informed consent is important in transition surgery. Just wanted to make that clear.)

What I’m trying to say and perhaps doing a poor job of it is. People are complicated, people are weird and people don’t always fit into neat little categories. That’s true for cis and trans people alike.
So our outcomes might not always be perfect fits either. There will be nuances. As in all things

This is why I support politicians getting the hell out of the way. Doctors may make mistakes like any human. But politics shouldn’t come between a doctor and their patient, ideally. I know that’s not reality. But reality also has shown me that politicians getting in the way of medicine for any reason whatsoever tends to harm far more than help. See the complications made due to abortion laws just for an easy example

 

[icehorse]

This is why I support politicians getting the hell out of the way. Doctors may make mistakes like any human. But politics shouldn’t come between a doctor and their patient, ideally. I know that’s not reality. But reality also has shown me that politicians getting in the way of medicine for any reason whatsoever tends to harm far more than help. See the complications made due to abortion laws just for an easy example

I agree that politicians should back off of this sort of question. My concern really is with trans-activists who promote these sorts of irreversible interventions to kids, and with those who profit from these interventions.

 

[icehorse]

I don't see any spin in pointing out that certain positions are more likely to impede access to necessary medical care than others. The link in the OP is an example of how medical research is continually improved via peer review and evidence, which only reinforces that expert consensus is much more reliable for medical guidance than ideologically or politically charged opinions (e.g., some politicians' support for banning gender-affirming care for minors).

The NHS currently doesn't recommend "routinely commissioning" puberty-suppressing hormones to minors either, which I pointed out earlier, so I'm also not sure what you were inferring from the excerpt in the OP.

Sadly, politics seem to be thoroughly intertwined with this issue. I think trans-activists have also done a lot to stir the pot. We really have to look at the fact that there has been a 2,000% increase in people identifying as trans in the last decade. Knowing everything we know about the power of propaganda and the negative side effects of social media, and applying Occam's razor, I think it would be an extraordinary claim to content that coercion is not a significant factor. In such an environment, it seems to me that performing irreversible interventions is an extraordinary solution. So I think to justify that, extraordinary evidence ought to be required.

I understand that politicians have entered into the mix, and I agree that that's concerning. But so have trans-activists, and that's equally concerning.