My, admittedly limited, understanding is that in the NHS puberty blockers have for years been used in certain cases of early puberty. This is usually considered to be before 8 in children assigned female at birth and before 9 in children assigned male at birth. (and presumably not experiencing gender dysphoria). The treatment is only (mainly in the case of boys) to allow a bit more growth if projected short height in adulthood is thought to risk emotional problems -and so is usually only for a few years. In girls the treatment is intended to prevent early periods if that is thought likely to cause emotional or physical problems too.
So this is presumably why there is limited data (in the NHS at least) on the use of puberty blockers in children for more than 'a few years '.
In the case of trans children for how many years might the puberty blocker treatment need to be given?
In the case of trans children for how many years might the puberty blocker treatment need to be given?
If we're assuming that the trans children in question remain certain of their gender identity, then the pathway that makes sense would be puberty blockers followed by a transition to hormone therapy in order to induce the development of the desired secondary sexual characteristics.
So a trans girl would take puberty blockers to prevent the onset of male puberty, and continue taking blockers until she transitioned to a feminizing hormone regime that would cause her body to develop adult female characteristics. This feminizing regime would include antiandrogens to block the effects of testosterone. If she has her testicles surgically removed, then the antiandrogens become much less necessary.
Cass review recommended caution, not exclusion, for any treatment and drew attention to shortcomings of previous GIDs service. To those asking will always be MP who listens to demand for better research & evidence base for help for those with gender dysphoria, not abandons them.
When I tweeted about the parliamentary prayer breakfast recently, what I saw in my social media was fairly representative of whenever I mention my faith – not just hostility, but fear. Lots of people fear religious legislators because they think we will seek to impose orthodox religious teaching on people who aren’t religious – particularly on social issues like abortion, LGBT rights or assisted dying.
Whatever view people take on those issues, the fundamental message of Christianity is love, compassion and care for others. I’m so sad that when people think about a Christian in politics, their first thought isn’t: They’ll be motivated by love and compassion and care for others. It’s: They’ll vote against my rights
He's just proved those who feared him tweeting about prayer breakfasts completely right. He did indeed come for the rights of people who disagree with him on social issues, and almost the instant he got power too. And his anti-LGBT pal he mentions glowingly in that article just got made minister for social security and disability instead of this person who disability campaigners actually wanted
I'm sorry but Starmer and his top team are oppressors and persecutors on this one, and those few Labour people who've spoken out against them don't have the power to stop them.
I'm sorry but Starmer and his top team are oppressors and persecutors on this one, and those few Labour people who've spoken out against them don't have the power to stop them.
Streeting has been tweeting out trying to justify his ban today:
I'm sorry but Starmer and his top team are oppressors and persecutors on this one, and those few Labour people who've spoken out against them don't have the power to stop them.
Streeting has been tweeting out trying to justify his ban today:
I'm with Jolyon. That's an excellent response. I think Streeting is doing the wrong thing for the right reasons. I think he feels that this is what the Cass Report means he has to do. Which is why I think Maugham's response is so good; it offers a morally and politically acceptable alternative.
I watch with interest.
As to a wider point, Streeting stated this in his thread:
"Medicine given to children must always be proven safe and effective first."
I put this out to a WhatsApp group of my colleagues - experienced paediatric surgeons from several countries.
If we adhere to that statement, we would stop a lot of treatments currently in use. Our evidence for so much of what we do is very limited. I think both Cass and Streeting do not appreciate this fact.
This is leading parents of trans+ youth to pursue emigrating from the UK in order for their children to access their medication. Yes, shamefully it has reached that point. Streeting is gay and is actively harming an already marginalised part of the community.
The BMA is going to undertake a review of the Cass report, calling for a pause in implementation of the Cass report until that review is completed. MBA Press Release
Professor Banfield said:
“The task and finish group will make recommendations to improve the healthcare system that has, for too long, failed transgender patients. It will work with patients to ensure the evaluation invokes the old adage in medicine of ‘no decision about me without me’. It is time that we truly listen to this group of important, valued, and unfortunately often victimised people and, together, build a system in which they are finally provided with the care they deserve.”
I saw that and wondered if it will get any traction. On the one hand, it is the BMA. On the other, I'm not sure whether the government really is in a position to allow them to veto the conclusions of an independent report.
Note: I don't like the conclusions of the Cass report
I suspect they'll write a report which will get media attention but nothing much else will happen. I hope I'm wrong.
I saw that and wondered if it will get any traction. On the one hand, it is the BMA. On the other, I'm not sure whether the government really is in a position to allow them to veto the conclusions of an independent report.
The government could turn around today and acknowledge what everyone already knows - that the previous government commissioned a report to give them the excuse to deny proper care to trans kids and stoke their culture war agenda. Badenoch has been bragging about it. The current government won't do that because they're (a) cowards, (b) pretty transphobic themselves and (c) willing to throw trans people under the bus if it will appease the Telegraph.
Still, it underlines the point that the treatment of trans people is a medical issue not a political one. Or, should be, but now politicised by the right wing, and unfortunately, the Labour govt.
"Medicine given to children must always be proven safe and effective first."
How does Streeting imagine that medicine is determined to be "safe and effective"?
I think this specific statement qualifies as "well-meaning idiot". It sounds like it makes sense, if you haven't actually looked at the details of how medical practice works, as you point out.
"Medicine given to children must always be proven safe and effective first."
How does Streeting imagine that medicine is determined to be "safe and effective"?
I think this specific statement qualifies as "well-meaning idiot". It sounds like it makes sense, if you haven't actually looked at the details of how medical practice works, as you point out.
Indeed.
Only a month in. Too soon to judge anyone but this issue aside, Streeting's done ok so far. Not sure what's going on here. Having heard an excellent interview with Streeting, I don't think he's transphobic or malicious. I think he's just wrong on this. I say this because it gives me hope. BMA putting a position together. I think the RCPCH* is more likely to carry weight with the DoH but I think he can be won over. Maybe.
AFZ
*RCPCH - Royal College of Paediatrics and Child Health
No sorry, AFZ, I really appreciate your medical input but Streeting has said transphobic things and supported transphobic positions. He came out with the separate hospital ward stuff!
As I pointed out earlier - and as a quick look even at his Wikipedia entry can tell you, it's not just one thing.
When asked if transgender women can be women on a Talkradio interview show, he was applauded by Julia Hartley-Brewer for his response, stating: "Men have penises, women have vaginas; here ends my biology lesson."[3]
In January 2024, he voiced his support for putting transgender hospital patients in their own, separate, ward. In the months leading up to the 2024 general election, Streeting also faced criticism from the LGBT community for saying that he regrets once saying that "trans women are women, trans men are men". He has also said it's wrong to claim that gender-critical feminists are "bigoted", and apologised to Canterbury MP Rosie Duffield, who has become known for her contentious views on trans people.[82] After the 2024 general election, Streeting defended the previous Conservative Government's ban on private prescriptions of puberty blockers.[83
I don't know of anyone trans who approves of what he's done so far or who even feels safe with him and Starmer in charge
eg. here's India Willoughby's point of view
Can you find me anyone trans who feels safe with him and Keir Starmer in charge? Bonus points if they're not a Labour Party activist - though I've seen at least one person who left over the transphobia in the party
I'd love it if Streeting backed down but the state of transphobia in this country and its grip in UK media institutions and political parties mean I don't dare hope at the moment.
This is leading parents of trans+ youth to pursue emigrating from the UK in order for their children to access their medication. Yes, shamefully it has reached that point. Streeting is gay and is actively harming an already marginalised part of the community.
I honestly think that saying 'Streeting's done ok so far' is to a significant extent talking over trans people and ignoring what it seems many trans people are telling Labour supporters about their experience of Labour both in the campaign and in government.
I honestly think that saying 'Streeting's done ok so far' is to a significant extent talking over trans people and ignoring what it seems many trans people are telling Labour supporters about their experience of Labour both in the campaign and in government.
Fair enough. I'm sorry. I am trying to find my way through this as a definite outsider.
It's not about me but I have found my own journey fascinating. I have no dog in this fight. No close relatives or friends who have lived this. I've found this thread irresistible because the injustice here is so blatant. That, coupled with an (deliberate or otherwise) abuse of the science, makes me want to speak up. I think the Cass Report is unconsciousable. I heard a journalist who I hugely respect generally call a critic a 'Cass-denier' which made my blood run cold.
I have no doubt that the change of government is an improvement. The culture wars waged by the previous one were horrific. I do not expect that to be of any comfort to Trans people. Nor should it be as a marginal gain or possibly a distinction without a difference is of no value to those whose existence is under threat.
Meh, I am struggling to find the right words.
Is it that some people, who are otherwise righteous and have a deep sense of social justice have a blindspot when it comes to Trans issues? That was quite possibly me, a few years ago...
We all rely on heuristics to navigate issues where we don’t have personal experience and I suspect with trans issues the heuristics are misleading for many well-intentioned people. Why exactly is a good question but I suspect the incredibly fraught state of gender politics in general is a big part of the answer. I’m fairly certain I would be hopelessly confused about nonbinary transgenderism if I weren’t nonbinary myself…
I feel Hilary Cass is being maligned, by implication, on this thread. From what I've managed to glean she does not intend anything but good for young people who are trans, non-binary, or questioning their gender identity. I therefore don't believe she would willingly agree to her name being attached to a Report that could be interpreted as 'unconscionable ' (as per AFZ). In other words, to call the Report 'unconscionable ' etc is to imply something about Hilary Cass herself.
I feel Hilary Cass is being maligned, by implication, on this thread. From what I've managed to glean she does not intend anything but good for young people who are trans, non-binary, or questioning their gender identity. I therefore don't believe she would willingly agree to her name being attached to a Report that could be interpreted as 'unconscionable ' (as per AFZ). In other words, to call the Report 'unconscionable ' etc is to imply something about Hilary Cass herself.
That's a good point.
Clearly there is a lot of politics here but even if we put that aside, the Cass Report says the following:
1. We have no proof that Puberty blockers are safe and effective.
2. Therefore they shouldn't be used
Obviously, I paraphrase, but this is really dangerous. We know how high the risk of self-harm is in this group of young people without treatment. To not allow weighing one risk against another, is why I used such strong language.
There is some limited evidence that PBs are effective in this group and clear rationale for their use. There is indirect evidence of safety and no direct evidence of harms. There is a lot of evidence of harm from a lack of appropriate treatment.
Therefore a fair conclusion would have urged caution rather than halted treatment. I think my critique is fair because this report was set the brief of giving a definitive answer. The honest definitive answer is that the are significant gaps in the evidence. The argument that the report advocated for better mental health support as part of the package is in this context just hand-waving, in my view.
I review a lot of papers for journals and one of my very common criticisms is when authors overstate the findings. My point here, is that in a report like this with such weight and consequence, over-claiming creates significant risk of harm.
I will again state that my expertise is very limited here. I am open to the possibility that I am wrong. I also have only read parts of the report not all. (Time... obviously. Sorry). But I maintain my grave concerns.
This Report from Yale has been referred to already in this thread; I quote from the introduction:
As researchers and pediatric clinicians with experience in the field of transgender healthcare, we read the Review with great interest. The degree of financial investment and time spent is impressive. Its ability to publish seven systematic reviews, conduct years’ worth of focus groups and deeply investigate care practices in the UK is admirable. We hoped it would improve the public’s awareness of the health needs of transgender youth and galvanize improvements in delivery of this care. Indeed, statements of the Review favorably describe the individualized, age-appropriate, and careful approach recommended by the World Professional Association for Transgender Health (WPATH) and the Endocrine Society.
Unfortunately, the Review repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculation. Many of its statements and the conduct of the York SRs reveal profound misunderstandings of the evidence base and the clinical issues at hand. The Review also subverts widely accepted processes for development of clinical recommendations and repeats spurious, debunked claims about transgender identity and gender dysphoria.
Now if that critique is fair - and I believe it is - then 'unconscionable' seems like the most appropriate word.
P.S. If you have a few minutes to read some of the Yale Report, Section 3 is what I was talking about in terms of paediatric practice. The section when they compare the level of evidence in neonatology is my everyday, working life - as a paeds surgeon, I work very closely with neonatologists. My PhD is in Necrotising Enterocolitis - which is the most common surgical emergency in neonates and I have literally written the book on this (out in September!*): A constant refrain in this book is pointing out the gaps in the evidence.
P.P.S. Sections 2 and 4 highlight features that would have had the report rejected by any high-quality peer-review journal. In short: Section 2 points out that they misused the GRADE system on the quality of evidence. You cannot do this when publishing a clinical guideline. Section 4 shows how they misrepresent their own data. I would expect even inexperienced peer-reviewers to pick up on this. I certainly would.
Again, the be clear: for a report of this import, such errors are unforgivable.
If Cass is being 'maligned' where are the trans people saying so? They would know - it's their lives and treatment we're talking about.
Lots of bad medicine and prejudice has good intentions - look at things like eugenics and conversion therapy. In the end you have to ask the people on the receiving end and listen to what they say and beware of institutional and systematic prejudice against certain sorts of people. It used to be respectable scientific opionion that gay people were mentally ill or certain races were inferior. There is a lot of polite bigotry towards trans people held by and fostered by respectable powerful and well-connected people.
If people don't know why Hilary Cass's report is being so poorly received I suggest reading some of the feedback from the people it's supposedly meant to 'help' and following journalism by trans people who know the ill effects it's had already.
I’ve been meaning to read the Cass report so as to be able to comment intelligently about it on this thread but somehow something more pressing, important, and/or enjoyable has always been moving this down my priority list and at this point I think I’m going to have to accept that it’s not gonna happen.
My big picture concern about the report - and what conversely seems to have the antitransgender crowd dancing in the street - is that it seems to roll back a hard-won victory for trans people which was the clinical acceptance of the basic correctness of the account of gender identity that has come out of the cumulative experience of trans and nonbinary people over the last however many decades. Once that was accepted then it becomes reasonable to believe that transition (including early transition) would be appropriate for at least some people, even if its effectiveness hasn’t been proved six ways to Sunday. Which is not to say that continued research isn’t important and obviously saying that transition is appropriate for some people leaves open important questions like who and when and under what circumstances. But the approach recommended by the report seems to reflect a view that anything can now be true about transgenderism if it hasn’t definitively been proven false.
I feel Hilary Cass is being maligned, by implication, on this thread. From what I've managed to glean she does not intend anything but good for young people who are trans, non-binary, or questioning their gender identity. I therefore don't believe she would willingly agree to her name being attached to a Report that could be interpreted as 'unconscionable ' (as per AFZ). In other words, to call the Report 'unconscionable ' etc is to imply something about Hilary Cass herself.
That's a good point.
Clearly there is a lot of politics here but even if we put that aside, the Cass Report says the following:
1. We have no proof that Puberty blockers are safe and effective.
... when used in cases where someone is suffering from gender dysphoria, meaning presumably that you can have a situation where a child is originally prescribed puberty blockers due to early onset puberty, but it later becomes unsafe and ineffective to do so because they've expressed feelings of gender dysphoria.
I feel Hilary Cass is being maligned, by implication, on this thread. From what I've managed to glean she does not intend anything but good for young people who are trans, non-binary, or questioning their gender identity. I therefore don't believe she would willingly agree to her name being attached to a Report that could be interpreted as 'unconscionable ' (as per AFZ). In other words, to call the Report 'unconscionable ' etc is to imply something about Hilary Cass herself.
That's a good point.
Clearly there is a lot of politics here but even if we put that aside, the Cass Report says the following:
1. We have no proof that Puberty blockers are safe and effective.
... when used in cases where someone is suffering from gender dysphoria, meaning presumably that you can have a situation where a child is originally prescribed puberty blockers due to early onset puberty, but it later becomes unsafe and ineffective to do so because they've expressed feelings of gender dysphoria.
Yes. Sorry, my sentence is a little unclear. Though I think everyone reading the thread would get it.
Both gender dysphoria and precocious puberty are rare conditions with no known link between them. Hence the same individual having both would be exceedingly rare. However the point remains valid. Puberty blockers for precocious puberty used in early childhood is accepted practice. Is it logical to suggest that there may be a different safety profile in adolescence? Actually that's not unreasonable. There are concerns about bone density, reproductive health and brain development. Sex hormones play a role in each of these in adolescence. However - and it's a massive 'however' - the data we have does not support the level of concern that has been suggested on the basis of Cass.
It's an interesting hypothetical though. Although in other clinical situations, it is known for a drug to be given for one indication and inadvertently treating another condition.
Two of Hilary Cass's colleagues have blown the whistle on her views. They allege:
Dr. Cass expressed her dismay and shock at the practice of medical transition to one of us before she started this review, and recommended strongly that we read the gender critical polemic ‘Irreversible Damage’ on the subject. She is described on the Cass Review website as an expert who came in with no fixed views—we will leave the reader to draw their own conclusions.
(if you want to know how bad recommending that book is, see the article)
We all rely on heuristics to navigate issues where we don’t have personal experience and I suspect with trans issues the heuristics are misleading for many well-intentioned people. Why exactly is a good question but I suspect the incredibly fraught state of gender politics in general is a big part of the answer. I’m fairly certain I would be hopelessly confused about nonbinary transgenderism if I weren’t nonbinary myself…
I think it's possible for well-intentioned people to have a range of views about what transgenderism is (because we don't really know what it is or how it works), and it's possible for well-intentioned people to have a range of views about some of the fringe issues surrounding trans people (such as whether and under what circumstances it is "fair" for trans women to compete against cis women in sports.) And there are a range of reasonable views about the extent to which modesty taboos as regards changing rooms etc. depend on gender vs visible genitalia.
But it's not reasonable to assume that trans people are lying when they describe how they experience the world, and all the common social situations are really quite straightforward. In the vast majority of social situations, I have no business enquiring about either an interlocutor's genitals or their chromosomes. I won't be engaging with either one, therefore it's not any of my business.
But it's not reasonable to assume that trans people are lying when they describe how they experience the world
I don't think anyone thinks they're lying. But it is possible to be honestly mistaken, even about ourselves, and especially during such an emotionally and physically turbulent period as adolescence. Always assuming that someone who reports as transgender is mistaken about that is clearly wrong, but I would suggest that always assuming they're right is wrong as well.
Instead, I would advocate for them being offered genuinely open-minded counselling that allows them to work through their feelings and fully understand themselves (as well as anyone can, anyway!) without being pushed in either direction by the beliefs of others, and before being given potentially life-changing and irreversible medical treatments. To the extent that puberty blockers can enable that to happen without the equally life-changing and irreversible effects of puberty then I think they're a good thing, but if they're being used with the explicit intent of being a first step towards transition then I would have concerns.
But it's not reasonable to assume that trans people are lying when they describe how they experience the world
I don't think anyone thinks they're lying. But it is possible to be honestly mistaken, even about ourselves, and especially during such an emotionally and physically turbulent period as adolescence. Always assuming that someone who reports as transgender is mistaken about that is clearly wrong, but I would suggest that always assuming they're right is wrong as well.
However, as a working assumption, one would not unreasonably favour the idea that a person knows better what is going on in their own head than someone not directly privy to their thought processes, barring absolute direct evidence to the contrary (as is the case in psychotic delusions)
Instead, I would advocate for them being offered genuinely open-minded counselling that allows them to work through their feelings and fully understand themselves (as well as anyone can, anyway!) without being pushed in either direction by the beliefs of others, and before being given potentially life-changing and irreversible medical treatments. To the extent that puberty blockers can enable that to happen without the equally life-changing and irreversible effects of puberty then I think they're a good thing, but if they're being used with the explicit intent of being a first step towards transition then I would have concerns.
As I understand it, that is exactly what happens, as opposed to the version pushed by the right wing press and fellow travellers where Trans zealots (who are bizarrely generally cis-gender themselves) jump on unsuspecting children to convince them that they are in fact trans.
However, as a working assumption, one would not unreasonably favour the idea that a person knows better what is going on in their own head than someone not directly privy to their thought processes, barring absolute direct evidence to the contrary (as is the case in psychotic delusions)
The comparison you raise is not about whether someone knows what's going on in their head better than anyone else or not (a person with psychotic delusions is still reporting accurately about what's going on in their head), nor even about whether the reality outside their head provides direct evidence to the contrary or not (I would suggest that someone's physical body and/or genetics could be said to provide such evidence), but is instead about whether society considers their internal or external reality to be the "correct" one. In one case we say that the person's internal reality is false and needs medical intervention to correct it, and in the other we say that the person's external reality is false and needs medical intervention to correct it.
However, as a working assumption, one would not unreasonably favour the idea that a person knows better what is going on in their own head than someone not directly privy to their thought processes, barring absolute direct evidence to the contrary (as is the case in psychotic delusions)
The comparison you raise is not about whether someone knows what's going on in their head better than anyone else or not (a person with psychotic delusions is still reporting accurately about what's going on in their head), nor even about whether the reality outside their head provides direct evidence to the contrary or not (I would suggest that someone's physical body and/or genetics could be said to provide such evidence), but is instead about whether society considers their internal or external reality to be the "correct" one. In one case we say that the person's internal reality is false and needs medical intervention to correct it, and in the other we say that the person's external reality is false and needs medical intervention to correct it.
I think you're confusing sex and gender identity here. Physical bodies and genetics can only provide evidence of sex. Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind. No-one is suggesting that any external reality is false and not all trans people want or need medical intervention.
Instead, I would advocate for them being offered genuinely open-minded counselling that allows them to work through their feelings and fully understand themselves (as well as anyone can, anyway!) without being pushed in either direction by the beliefs of others, and before being given potentially life-changing and irreversible medical treatments. To the extent that puberty blockers can enable that to happen without the equally life-changing and irreversible effects of puberty then I think they're a good thing, but if they're being used with the explicit intent of being a first step towards transition then I would have concerns.
As I understand it, that is exactly what happens, as opposed to the version pushed by the right wing press and fellow travellers where Trans zealots (who are bizarrely generally cis-gender themselves) jump on unsuspecting children to convince them that they are in fact trans.
That's what ideally would have happened, in reality the provision of such services in the UK seems to have been patchy at best, with health services being deliberately obstructive or simply not knowing the pathways for treatment - and patients and families struggling to access treatment (with treatments for transition itself being orders of magnitude more difficult to access unless one had large sums available to go private or abroad).
Instead, I would advocate for them being offered genuinely open-minded counselling that allows them to work through their feelings and fully understand themselves (as well as anyone can, anyway!) without being pushed in either direction by the beliefs of others, and before being given potentially life-changing and irreversible medical treatments. To the extent that puberty blockers can enable that to happen without the equally life-changing and irreversible effects of puberty then I think they're a good thing, but if they're being used with the explicit intent of being a first step towards transition then I would have concerns.
As I understand it, that is exactly what happens, as opposed to the version pushed by the right wing press and fellow travellers where Trans zealots (who are bizarrely generally cis-gender themselves) jump on unsuspecting children to convince them that they are in fact trans.
That's what ideally would have happened, in reality the provision of such services in the UK seems to have been patchy at best, with health services being deliberately obstructive or simply not knowing the pathways for treatment - and patients and families struggling to access treatment (with treatments for transition itself being orders of magnitude more difficult to access unless one had large sums available to go private or abroad).
Yeah, my point was that the TERF version of what happens is utter nonsense.
Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind.
This is true, of course, but I can't help wondering if the only reason it's true is because it was defined as such precisely in order to avoid any difficult questions raised by a person's physical reality.
My only difficulty with that definition is the inherent dualism. It's too neat. I want it to be true, and tend to behave as if it were, but can't totally convince myself that it is. Mind and body make a whole, all elements of which interrelate.
ETA: there is still the question of who gets to adjudicate. In individual cases, I think it has to be the individual, but the question can still be debated in the abstract by society as a whole.
My only difficulty with that definition is the inherent dualism. It's too neat. I want it to be true, and tend to behave as if it were, but can't totally convince myself that it is. Mind and body make a whole, all elements of which interrelate.
I don't think anyone is pretending it's a neat dualism; which is reflected in the varying outcomes from the treatment process. So separately those who don't transition, those who define themselves as non-binary in some way, those who transition, and then overlaid with combinations of social and medical transition.
Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind.
This is true, of course, but I can't help wondering if the only reason it's true is because it was defined as such precisely in order to avoid any difficult questions raised by a person's physical reality.
Well, no, not really; our sense of identity, of self, is a mental construct. It can't really be defined any other way. In that way it's like our sexual orientation, our food preference, whether we have an inner dialogue or are able to visualise objects mentally. It's a function of the mind. Sure there may be physiological factors which influence that mental construct, which is why it's not a clear neat dualism, but in the mind is where it actually resides.
The only way out of the bind would be to deny the existence of gender identity altogether, but from a scientific viewpoint the problem with that is that the absence of gender identity has less explanatory power than gender identity does, which doesn't favour models which don't have it.
but is instead about whether society considers their internal or external reality to be the "correct" one. In one case we say that the person's internal reality is false and needs medical intervention to correct it, and in the other we say that the person's external reality is false and needs medical intervention to correct it.
We know how to prescribe hormones for people. We know how to perform surgery to alter what people look like.
We don't know how to change someone's perception of their gender. The closest we come to that sort of thing is "conversion therapy". In the case of conversion therapy for homosexual people, there is ample evidence that it doesn't work and is actively harmful. It is reasonable to assume that a similar effort to provide "conversion therapy" to trans people would also not work, and be actively harmful. There is at least anecdotal evidence to support this statement.
The only way out of the bind would be to deny the existence of gender identity altogether, but from a scientific viewpoint the problem with that is that the absence of gender identity has less explanatory power than gender identity does, which doesn't favour models which don't have it.
Not sure this is true.
Gender identity certainly exists as a classification, but I don't think it has any explanatory power at all, because there isn't any explanation.
All of the "explanatory power" are really thinly-disguised tautologies. It's like saying that you can explain why someone likes popping round to the Emirates stadium to watch a game of football - it's because they're an Arsenal fan.
That's not an explanation. The fact that they enjoy watching Arsenal play football is one of the things that makes them an Arsenal fan.
The only way out of the bind would be to deny the existence of gender identity altogether, but from a scientific viewpoint the problem with that is that the absence of gender identity has less explanatory power than gender identity does, which doesn't favour models which don't have it.
Not sure this is true.
Gender identity certainly exists as a classification, but I don't think it has any explanatory power at all, because there isn't any explanation.
All of the "explanatory power" are really thinly-disguised tautologies. It's like saying that you can explain why someone likes popping round to the Emirates stadium to watch a game of football - it's because they're an Arsenal fan.
That's not an explanation. The fact that they enjoy watching Arsenal play football is one of the things that makes them an Arsenal fan.
I disagree. The concept of gender identity as a thing separate from biological bits explains how transgender people can exist.
This why the people who deny transgender people exist deny the existence of gender identity altogether.
The only way out of the bind would be to deny the existence of gender identity altogether, but from a scientific viewpoint the problem with that is that the absence of gender identity has less explanatory power than gender identity does, which doesn't favour models which don't have it.
Gender identity certainly exists as a classification, but I don't think it has any explanatory power at all, because there isn't any explanation.
That's not an explanation. The fact that they enjoy watching Arsenal play football is one of the things that makes them an Arsenal fan.
I think you mean that we don't really understand the mechanics behind gender identity, so there's no 'explanation' for gender identity, but vis @KarlLB above; gender identity as something that's somewhat disjoint from biology explains trans and non-binary people.
The best evidence for gender identity (roles, behaviours etc) is that gender is performed differently in different societies. I remember my father being asked, in an Arab country when I was a child, why he dressed like a woman. In that context, the questioner meant why was he wearing trousers rather than a futah or a thobe.
So we know that doing gender means more than just looking at your body in a mirror.
I disagree. The concept of gender identity as a thing separate from biological bits explains how transgender people can exist.
This why the people who deny transgender people exist deny the existence of gender identity altogether.
We observe that trans people exist. There are a set of people who report a similar self-image. We assign the label "trans people" to this set of people.
Gender identity is a model that we use to help describe people. Perhaps gender exists as some ontological truth. Perhaps it's a useful myth that is convenient to use. Perhaps it's an approximate model that is mostly true, but fails in some cases. I don't think I can argue for the truth of any of these positions.
But I don't think you need gender identity to exist as some real thing in order to "explain" trans people. If you don't assume that all bio-female people have to think in way X, and bio-male people have to think in way Y, then there isn't any kind of problem with the observed existence of trans people.
The gender-deniers are not in fact denying the existence of gender identity. They require it to exist for their position to make any sense at all, and they then assert that it is 100% correlated with biological sex.
I don't think gender has to be a real thing at all. It can just be a mostly-convenient label.
I appreciate that the level of transphobia has dropped a bit since the last time I was here. Not sure I can cope with staying yet - I'm used to the Fediverse now, where transphobia just gets instantly binned - but things have definitely improved.
Tangential to the main discussion here but for the record, the wider trans community has known Streeting is a transphobe for some time now. It's one reason many of us voted Green at the General Election. Labour aren't trusted.
There's plenty more but you get the idea. Starmer too for the record. The last time I can recall him saying anything affirming was in the leadership election, and pretty much everything he pledged there turned out to be a pack of lies.
For those discussing gender and what it is, sometimes gender feels like a cis concept to me. For instance, society says I am a woman. I say no, I do not feel like a woman, I do not think so. "But you look so soft and feminine." They are wrong. If I am soft, that has nothing to do with being feminine. Who I am is not defined by how I look. If I look honest does that mean they will trust me? No, it's just my gender I'm not allowed to decide... Pardon the rant.
Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind.
This is true, of course, but I can't help wondering if the only reason it's true is because it was defined as such precisely in order to avoid any difficult questions raised by a person's physical reality.
Doesn’t “Gender identity by definition is a mental construct” rely on existentialism? I.e., that meaning is something we impose on reality rather than derive from reality? What if one doesn’t believe that?
Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind.
This is true, of course, but I can't help wondering if the only reason it's true is because it was defined as such precisely in order to avoid any difficult questions raised by a person's physical reality.
Doesn’t “Gender identity by definition is a mental construct” rely on existentialism? I.e., that meaning is something we impose on reality rather than derive from reality? What if one doesn’t believe that?
Sounds like another way to attempt to logic trans people out of existence.
I think quite a lot of the argument derives from different understandings of what truth means. In a social constructionist understanding of the world the idea of gender identity is unremarkable. (wiki gives this.)
In this way of seeing the world, things like childhood, money and justice are also social constructs and of course also real.
Comments
So this is presumably why there is limited data (in the NHS at least) on the use of puberty blockers in children for more than 'a few years '.
In the case of trans children for how many years might the puberty blocker treatment need to be given?
If we're assuming that the trans children in question remain certain of their gender identity, then the pathway that makes sense would be puberty blockers followed by a transition to hormone therapy in order to induce the development of the desired secondary sexual characteristics.
So a trans girl would take puberty blockers to prevent the onset of male puberty, and continue taking blockers until she transitioned to a feminizing hormone regime that would cause her body to develop adult female characteristics. This feminizing regime would include antiandrogens to block the effects of testosterone. If she has her testicles surgically removed, then the antiandrogens become much less necessary.
Or at least better.
https://x.com/stellacreasy/status/1812188020587585905?t=I4fZMXr_gYHJxw2Bewmx2g&s=19
https://www.premierchristianity.com/interviews/wes-streeting-mp-my-faith-made-it-very-difficult-to-accept-my-sexuality/15973.article
And then had the brass neck to say
He's just proved those who feared him tweeting about prayer breakfasts completely right. He did indeed come for the rights of people who disagree with him on social issues, and almost the instant he got power too. And his anti-LGBT pal he mentions glowingly in that article just got made minister for social security and disability instead of this person who disability campaigners actually wanted
https://www.disabilitynewsservice.com/anger-and-frustration-over-labours-disgraceful-decision-not-to-appoint-foxcroft-as-disability-minister/
I'm sorry but Starmer and his top team are oppressors and persecutors on this one, and those few Labour people who've spoken out against them don't have the power to stop them.
Streeting has been tweeting out trying to justify his ban today:
https://threadreaderapp.com/thread/1812435914473295927.html
Jolyon Maugham has responded:
https://threadreaderapp.com/thread/1812456173259391473.html
I'm with Jolyon. That's an excellent response. I think Streeting is doing the wrong thing for the right reasons. I think he feels that this is what the Cass Report means he has to do. Which is why I think Maugham's response is so good; it offers a morally and politically acceptable alternative.
I watch with interest.
As to a wider point, Streeting stated this in his thread:
"Medicine given to children must always be proven safe and effective first."
I put this out to a WhatsApp group of my colleagues - experienced paediatric surgeons from several countries.
If we adhere to that statement, we would stop a lot of treatments currently in use. Our evidence for so much of what we do is very limited. I think both Cass and Streeting do not appreciate this fact.
It is extremely disappointing to be here.
AFZ
That's a thought. Probably it needs to come from the paediatricians. I'd be very interested to see what the RCPCH are doing...
'Labour has the potential to be the catalyst for change, but looks set to fail its first test'
https://www.attitude.co.uk/news/labour-marty-davies-opinion-469694/
Note: I don't like the conclusions of the Cass report
I suspect they'll write a report which will get media attention but nothing much else will happen. I hope I'm wrong.
The government could turn around today and acknowledge what everyone already knows - that the previous government commissioned a report to give them the excuse to deny proper care to trans kids and stoke their culture war agenda. Badenoch has been bragging about it. The current government won't do that because they're (a) cowards, (b) pretty transphobic themselves and (c) willing to throw trans people under the bus if it will appease the Telegraph.
How does Streeting imagine that medicine is determined to be "safe and effective"?
I think this specific statement qualifies as "well-meaning idiot". It sounds like it makes sense, if you haven't actually looked at the details of how medical practice works, as you point out.
Indeed.
Only a month in. Too soon to judge anyone but this issue aside, Streeting's done ok so far. Not sure what's going on here. Having heard an excellent interview with Streeting, I don't think he's transphobic or malicious. I think he's just wrong on this. I say this because it gives me hope. BMA putting a position together. I think the RCPCH* is more likely to carry weight with the DoH but I think he can be won over. Maybe.
AFZ
*RCPCH - Royal College of Paediatrics and Child Health
As I pointed out earlier - and as a quick look even at his Wikipedia entry can tell you, it's not just one thing.
https://en.m.wikipedia.org/wiki/Wes_Streeting
I don't know of anyone trans who approves of what he's done so far or who even feels safe with him and Starmer in charge
eg. here's India Willoughby's point of view
https://www.attitude.co.uk/life/india-willoughby-speaks-out-on-trans-rights-under-labour-469907/
And here Ugla Stefanía Kristjönudóttir Jónsdóttir 'As a trans person, I fear a Labour government'
https://metro.co.uk/2024/07/08/election-result-bittersweet-news-trans-people-21183746/
Can you find me anyone trans who feels safe with him and Keir Starmer in charge? Bonus points if they're not a Labour Party activist - though I've seen at least one person who left over the transphobia in the party
https://metro.co.uk/2024/06/06/a-proud-labour-party-member-this-year-20941473/
I'd love it if Streeting backed down but the state of transphobia in this country and its grip in UK media institutions and political parties mean I don't dare hope at the moment.
As Marty Davies put it about this policy
https://www.attitude.co.uk/news/labour-marty-davies-opinion-469694/
I honestly think that saying 'Streeting's done ok so far' is to a significant extent talking over trans people and ignoring what it seems many trans people are telling Labour supporters about their experience of Labour both in the campaign and in government.
Fair enough. I'm sorry. I am trying to find my way through this as a definite outsider.
It's not about me but I have found my own journey fascinating. I have no dog in this fight. No close relatives or friends who have lived this. I've found this thread irresistible because the injustice here is so blatant. That, coupled with an (deliberate or otherwise) abuse of the science, makes me want to speak up. I think the Cass Report is unconsciousable. I heard a journalist who I hugely respect generally call a critic a 'Cass-denier' which made my blood run cold.
I have no doubt that the change of government is an improvement. The culture wars waged by the previous one were horrific. I do not expect that to be of any comfort to Trans people. Nor should it be as a marginal gain or possibly a distinction without a difference is of no value to those whose existence is under threat.
Meh, I am struggling to find the right words.
Is it that some people, who are otherwise righteous and have a deep sense of social justice have a blindspot when it comes to Trans issues? That was quite possibly me, a few years ago...
AFZ
That's a good point.
Clearly there is a lot of politics here but even if we put that aside, the Cass Report says the following:
1. We have no proof that Puberty blockers are safe and effective.
2. Therefore they shouldn't be used
Obviously, I paraphrase, but this is really dangerous. We know how high the risk of self-harm is in this group of young people without treatment. To not allow weighing one risk against another, is why I used such strong language.
There is some limited evidence that PBs are effective in this group and clear rationale for their use. There is indirect evidence of safety and no direct evidence of harms. There is a lot of evidence of harm from a lack of appropriate treatment.
Therefore a fair conclusion would have urged caution rather than halted treatment. I think my critique is fair because this report was set the brief of giving a definitive answer. The honest definitive answer is that the are significant gaps in the evidence. The argument that the report advocated for better mental health support as part of the package is in this context just hand-waving, in my view.
I review a lot of papers for journals and one of my very common criticisms is when authors overstate the findings. My point here, is that in a report like this with such weight and consequence, over-claiming creates significant risk of harm.
I will again state that my expertise is very limited here. I am open to the possibility that I am wrong. I also have only read parts of the report not all. (Time... obviously. Sorry). But I maintain my grave concerns.
This Report from Yale has been referred to already in this thread; I quote from the introduction:
Now if that critique is fair - and I believe it is - then 'unconscionable' seems like the most appropriate word.
AFZ
P.P.S. Sections 2 and 4 highlight features that would have had the report rejected by any high-quality peer-review journal. In short: Section 2 points out that they misused the GRADE system on the quality of evidence. You cannot do this when publishing a clinical guideline. Section 4 shows how they misrepresent their own data. I would expect even inexperienced peer-reviewers to pick up on this. I certainly would.
Again, the be clear: for a report of this import, such errors are unforgivable.
*Sorry - just showing off here!
Lots of bad medicine and prejudice has good intentions - look at things like eugenics and conversion therapy. In the end you have to ask the people on the receiving end and listen to what they say and beware of institutional and systematic prejudice against certain sorts of people. It used to be respectable scientific opionion that gay people were mentally ill or certain races were inferior. There is a lot of polite bigotry towards trans people held by and fostered by respectable powerful and well-connected people.
If people don't know why Hilary Cass's report is being so poorly received I suggest reading some of the feedback from the people it's supposedly meant to 'help' and following journalism by trans people who know the ill effects it's had already.
My big picture concern about the report - and what conversely seems to have the antitransgender crowd dancing in the street - is that it seems to roll back a hard-won victory for trans people which was the clinical acceptance of the basic correctness of the account of gender identity that has come out of the cumulative experience of trans and nonbinary people over the last however many decades. Once that was accepted then it becomes reasonable to believe that transition (including early transition) would be appropriate for at least some people, even if its effectiveness hasn’t been proved six ways to Sunday. Which is not to say that continued research isn’t important and obviously saying that transition is appropriate for some people leaves open important questions like who and when and under what circumstances. But the approach recommended by the report seems to reflect a view that anything can now be true about transgenderism if it hasn’t definitively been proven false.
... when used in cases where someone is suffering from gender dysphoria, meaning presumably that you can have a situation where a child is originally prescribed puberty blockers due to early onset puberty, but it later becomes unsafe and ineffective to do so because they've expressed feelings of gender dysphoria.
Yes. Sorry, my sentence is a little unclear. Though I think everyone reading the thread would get it.
Both gender dysphoria and precocious puberty are rare conditions with no known link between them. Hence the same individual having both would be exceedingly rare. However the point remains valid. Puberty blockers for precocious puberty used in early childhood is accepted practice. Is it logical to suggest that there may be a different safety profile in adolescence? Actually that's not unreasonable. There are concerns about bone density, reproductive health and brain development. Sex hormones play a role in each of these in adolescence. However - and it's a massive 'however' - the data we have does not support the level of concern that has been suggested on the basis of Cass.
It's an interesting hypothetical though. Although in other clinical situations, it is known for a drug to be given for one indication and inadvertently treating another condition.
AFZ
(if you want to know how bad recommending that book is, see the article)
https://www.erininthemorning.com/p/colleagues-allege-cass-recommended
I think it's possible for well-intentioned people to have a range of views about what transgenderism is (because we don't really know what it is or how it works), and it's possible for well-intentioned people to have a range of views about some of the fringe issues surrounding trans people (such as whether and under what circumstances it is "fair" for trans women to compete against cis women in sports.) And there are a range of reasonable views about the extent to which modesty taboos as regards changing rooms etc. depend on gender vs visible genitalia.
But it's not reasonable to assume that trans people are lying when they describe how they experience the world, and all the common social situations are really quite straightforward. In the vast majority of social situations, I have no business enquiring about either an interlocutor's genitals or their chromosomes. I won't be engaging with either one, therefore it's not any of my business.
I don't think anyone thinks they're lying. But it is possible to be honestly mistaken, even about ourselves, and especially during such an emotionally and physically turbulent period as adolescence. Always assuming that someone who reports as transgender is mistaken about that is clearly wrong, but I would suggest that always assuming they're right is wrong as well.
Instead, I would advocate for them being offered genuinely open-minded counselling that allows them to work through their feelings and fully understand themselves (as well as anyone can, anyway!) without being pushed in either direction by the beliefs of others, and before being given potentially life-changing and irreversible medical treatments. To the extent that puberty blockers can enable that to happen without the equally life-changing and irreversible effects of puberty then I think they're a good thing, but if they're being used with the explicit intent of being a first step towards transition then I would have concerns.
However, as a working assumption, one would not unreasonably favour the idea that a person knows better what is going on in their own head than someone not directly privy to their thought processes, barring absolute direct evidence to the contrary (as is the case in psychotic delusions)
As I understand it, that is exactly what happens, as opposed to the version pushed by the right wing press and fellow travellers where Trans zealots (who are bizarrely generally cis-gender themselves) jump on unsuspecting children to convince them that they are in fact trans.
The comparison you raise is not about whether someone knows what's going on in their head better than anyone else or not (a person with psychotic delusions is still reporting accurately about what's going on in their head), nor even about whether the reality outside their head provides direct evidence to the contrary or not (I would suggest that someone's physical body and/or genetics could be said to provide such evidence), but is instead about whether society considers their internal or external reality to be the "correct" one. In one case we say that the person's internal reality is false and needs medical intervention to correct it, and in the other we say that the person's external reality is false and needs medical intervention to correct it.
Awesome.
I think you're confusing sex and gender identity here. Physical bodies and genetics can only provide evidence of sex. Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind. No-one is suggesting that any external reality is false and not all trans people want or need medical intervention.
That's what ideally would have happened, in reality the provision of such services in the UK seems to have been patchy at best, with health services being deliberately obstructive or simply not knowing the pathways for treatment - and patients and families struggling to access treatment (with treatments for transition itself being orders of magnitude more difficult to access unless one had large sums available to go private or abroad).
Yeah, my point was that the TERF version of what happens is utter nonsense.
This is true, of course, but I can't help wondering if the only reason it's true is because it was defined as such precisely in order to avoid any difficult questions raised by a person's physical reality.
ETA: there is still the question of who gets to adjudicate. In individual cases, I think it has to be the individual, but the question can still be debated in the abstract by society as a whole.
I don't think anyone is pretending it's a neat dualism; which is reflected in the varying outcomes from the treatment process. So separately those who don't transition, those who define themselves as non-binary in some way, those who transition, and then overlaid with combinations of social and medical transition.
Well, no, not really; our sense of identity, of self, is a mental construct. It can't really be defined any other way. In that way it's like our sexual orientation, our food preference, whether we have an inner dialogue or are able to visualise objects mentally. It's a function of the mind. Sure there may be physiological factors which influence that mental construct, which is why it's not a clear neat dualism, but in the mind is where it actually resides.
The only way out of the bind would be to deny the existence of gender identity altogether, but from a scientific viewpoint the problem with that is that the absence of gender identity has less explanatory power than gender identity does, which doesn't favour models which don't have it.
We know how to prescribe hormones for people. We know how to perform surgery to alter what people look like.
We don't know how to change someone's perception of their gender. The closest we come to that sort of thing is "conversion therapy". In the case of conversion therapy for homosexual people, there is ample evidence that it doesn't work and is actively harmful. It is reasonable to assume that a similar effort to provide "conversion therapy" to trans people would also not work, and be actively harmful. There is at least anecdotal evidence to support this statement.
Not sure this is true.
Gender identity certainly exists as a classification, but I don't think it has any explanatory power at all, because there isn't any explanation.
All of the "explanatory power" are really thinly-disguised tautologies. It's like saying that you can explain why someone likes popping round to the Emirates stadium to watch a game of football - it's because they're an Arsenal fan.
That's not an explanation. The fact that they enjoy watching Arsenal play football is one of the things that makes them an Arsenal fan.
I disagree. The concept of gender identity as a thing separate from biological bits explains how transgender people can exist.
This why the people who deny transgender people exist deny the existence of gender identity altogether.
I think you mean that we don't really understand the mechanics behind gender identity, so there's no 'explanation' for gender identity, but vis @KarlLB above; gender identity as something that's somewhat disjoint from biology explains trans and non-binary people.
So we know that doing gender means more than just looking at your body in a mirror.
We observe that trans people exist. There are a set of people who report a similar self-image. We assign the label "trans people" to this set of people.
Gender identity is a model that we use to help describe people. Perhaps gender exists as some ontological truth. Perhaps it's a useful myth that is convenient to use. Perhaps it's an approximate model that is mostly true, but fails in some cases. I don't think I can argue for the truth of any of these positions.
But I don't think you need gender identity to exist as some real thing in order to "explain" trans people. If you don't assume that all bio-female people have to think in way X, and bio-male people have to think in way Y, then there isn't any kind of problem with the observed existence of trans people.
The gender-deniers are not in fact denying the existence of gender identity. They require it to exist for their position to make any sense at all, and they then assert that it is 100% correlated with biological sex.
I don't think gender has to be a real thing at all. It can just be a mostly-convenient label.
I appreciate that the level of transphobia has dropped a bit since the last time I was here. Not sure I can cope with staying yet - I'm used to the Fediverse now, where transphobia just gets instantly binned - but things have definitely improved.
Tangential to the main discussion here but for the record, the wider trans community has known Streeting is a transphobe for some time now. It's one reason many of us voted Green at the General Election. Labour aren't trusted.
BBC - defending Rowling in early 2022
Independent - GCSE biology, later in 2022
Torygraph - denies trans women are women, April 2024
There's plenty more but you get the idea. Starmer too for the record. The last time I can recall him saying anything affirming was in the leadership election, and pretty much everything he pledged there turned out to be a pack of lies.
For those discussing gender and what it is, sometimes gender feels like a cis concept to me. For instance, society says I am a woman. I say no, I do not feel like a woman, I do not think so. "But you look so soft and feminine." They are wrong. If I am soft, that has nothing to do with being feminine. Who I am is not defined by how I look. If I look honest does that mean they will trust me? No, it's just my gender I'm not allowed to decide... Pardon the rant.
Doesn’t “Gender identity by definition is a mental construct” rely on existentialism? I.e., that meaning is something we impose on reality rather than derive from reality? What if one doesn’t believe that?
Sounds like another way to attempt to logic trans people out of existence.
In this way of seeing the world, things like childhood, money and justice are also social constructs and of course also real.