In many men who receive ADT, the symptoms of depression often are severe enough to warrant clinical intervention. Thus, it is reasonable for all men who receive ADT to be screened for depression and, if they screen positive, to more fully assess them and intervene accordingly.
Also:
A patient's sense of his masculinity may be impacted in different ways by ADT. Some patients may conceptualize their masculinity in a more physical sense and, thus, may be affected more by changes like bodily feminization, infertility, or loss of muscle mass. For other men, masculinity may be impacted more by social factors, including changes in relationships and roles, or by psychological factors, including changes in body image, loss of sexual function, and emotional lability.
It is important to note that there may be other potential explanations for changes in a man's sense of his own masculinity during ADT. The same study that documented an increase in loss of masculinity over time also demonstrated that depressive and anxious symptomatology was predictive of lower perceived masculinity. In addition, lowered sexual desire may be symptomatic of depression, which is also strongly associated with ED.
Yes, they (LHRH agonists - usually in the UK known as GnRH agonists) are powerful drugs. No wonder their use as puberty blockers is controversial.
In many men who receive ADT, the symptoms of depression often are severe enough to warrant clinical intervention. Thus, it is reasonable for all men who receive ADT to be screened for depression and, if they screen positive, to more fully assess them and intervene accordingly.
Also:
A patient's sense of his masculinity may be impacted in different ways by ADT. Some patients may conceptualize their masculinity in a more physical sense and, thus, may be affected more by changes like bodily feminization, infertility, or loss of muscle mass. For other men, masculinity may be impacted more by social factors, including changes in relationships and roles, or by psychological factors, including changes in body image, loss of sexual function, and emotional lability.
It is important to note that there may be other potential explanations for changes in a man's sense of his own masculinity during ADT. The same study that documented an increase in loss of masculinity over time also demonstrated that depressive and anxious symptomatology was predictive of lower perceived masculinity. In addition, lowered sexual desire may be symptomatic of depression, which is also strongly associated with ED.
Yes, they (LHRH agonists - usually in the UK known as GnRH agonists) are powerful drugs. No wonder their use as puberty blockers is controversial.
It's only "controversial" when used to treat trans people. No-one bats an eyelid otherwise.
In many men who receive ADT, the symptoms of depression often are severe enough to warrant clinical intervention. Thus, it is reasonable for all men who receive ADT to be screened for depression and, if they screen positive, to more fully assess them and intervene accordingly.
Also:
A patient's sense of his masculinity may be impacted in different ways by ADT. Some patients may conceptualize their masculinity in a more physical sense and, thus, may be affected more by changes like bodily feminization, infertility, or loss of muscle mass. For other men, masculinity may be impacted more by social factors, including changes in relationships and roles, or by psychological factors, including changes in body image, loss of sexual function, and emotional lability.
It is important to note that there may be other potential explanations for changes in a man's sense of his own masculinity during ADT. The same study that documented an increase in loss of masculinity over time also demonstrated that depressive and anxious symptomatology was predictive of lower perceived masculinity. In addition, lowered sexual desire may be symptomatic of depression, which is also strongly associated with ED.
Yes, they (LHRH agonists - usually in the UK known as GnRH agonists) are powerful drugs. No wonder their use as puberty blockers is controversial.
It's only "controversial" when used to treat trans people. No-one bats an eyelid otherwise.
I think we'll have to disagree about that on another thread!
In many men who receive ADT, the symptoms of depression often are severe enough to warrant clinical intervention. Thus, it is reasonable for all men who receive ADT to be screened for depression and, if they screen positive, to more fully assess them and intervene accordingly.
Also:
A patient's sense of his masculinity may be impacted in different ways by ADT. Some patients may conceptualize their masculinity in a more physical sense and, thus, may be affected more by changes like bodily feminization, infertility, or loss of muscle mass. For other men, masculinity may be impacted more by social factors, including changes in relationships and roles, or by psychological factors, including changes in body image, loss of sexual function, and emotional lability.
It is important to note that there may be other potential explanations for changes in a man's sense of his own masculinity during ADT. The same study that documented an increase in loss of masculinity over time also demonstrated that depressive and anxious symptomatology was predictive of lower perceived masculinity. In addition, lowered sexual desire may be symptomatic of depression, which is also strongly associated with ED.
Yes, they (LHRH agonists - usually in the UK known as GnRH agonists) are powerful drugs. No wonder their use as puberty blockers is controversial.
It's only "controversial" when used to treat trans people. No-one bats an eyelid otherwise.
I think we'll have to disagree about that on another thread!
But it is a fact. Using puberty blockers is not at all controversial when it comes to treating precocious puberty. That is their other use. Do you have any sources saying that using puberty blockers to treat precocious puberty is controversial?
Insulin is a powerful drug - and is also a form of hormone replacement therapy, just not sex hormone replacement therapy). Nobody uses this kind of tabloid-esque language to describe insulin. However, people do use this kind of language in talking about GLP-1 drugs (Ozempic etc) and it hasn't been lost on me that the rhetoric around weight loss medication ramped up once the puberty blocker issue was at least temporarily off the table.
In a previous life I wanted to explore the theology of eunuchs in the Bible as the intersection of gender and disability, and I think this thread is demonstrating why disability and gender are so linked to discussions of eunuchs. It very much seems to be a discussion about Good Bodies and Bad Bodies (and Good Marginalised People and Bad Marginalised People) - and I had forgotten until just now that fatness was very much part of the historical eunuch stereotype, so really coming full-circle with GLP-1 medication taking the place of puberty blockers in the tabloids (for the avoidance of doubt, I am a fat person who has been involved in fat activism since my teens, as well as trans and disabled).
I think cis people being able to have gender affirming surgery and destigmatising it is a good thing. I don't think that painting self-identifying eunuchs that desire an orchiectomy as being responsible for trans people having fewer rights is helpful to trans people - the people at fault are transphobes, not NHS Scotland being too inclusive. I don't have an issue with a cis man getting an elective orchiectomy, it's their body and it doesn't affect me. Cis people can have gender dysphoria too, likewise not all trans people do have gender dysphoria.
@Pomona and @Arethosemyfeet , on reflection I think it was not a good idea of me to raise the issue of puberty blockers on this thread.
I actually think that the type of discussion I would like to have with many knowledgeable people on this thread (and with other Shipmates not currently on this thread) cannot take place on any on-line discussion forum, including on this Ship. The potential for accidently 'saying' (ie typing) something that offends or gets misunderstood is just too great -for me at least.
This thread already has a lot of 'heavy' issues and I will continue to follow it and learn a lot. But I doubt I have anything further to contribute that would be helpful.
@Merry Vole while of course you can follow your own preferences with regards to involving yourself in discussion or not, it seems like a shame to:
1) not actually give a response to mine and @Arethosemyfeet 's replies - that seems like a bit of a cop-out, especially when "Do you have any sources saying that using puberty blockers to treat precocious puberty is controversial?" is a simple yes/no question;
2) frame meta discussions of disagreement within this discussion around offence or misunderstanding, when disagreement is neither of those things.
Also personally as an ND person I find online discussions MUCH less prone to misunderstanding than offline discussions, particularly as I have sensory processing issues which make taking in spoken information more difficult than taking in something I've read. For a lot of trans people - ND or not - discussing these things online also feels much safer than having a more personal offline discussion, even if that means experiencing more offence. It's much easier to escape if it does become too much, for one thing!
@Merry Vole while of course you can follow your own preferences with regards to involving yourself in discussion or not, it seems like a shame to:
1) not actually give a response to mine and @Arethosemyfeet 's replies - that seems like a bit of a cop-out, especially when "Do you have any sources saying that using puberty blockers to treat precocious puberty is controversial?" is a simple yes/no question;
2) frame meta discussions of disagreement within this discussion around offence or misunderstanding, when disagreement is neither of those things.
Also personally as an ND person I find online discussions MUCH less prone to misunderstanding than offline discussions, particularly as I have sensory processing issues which make taking in spoken information more difficult than taking in something I've read. For a lot of trans people - ND or not - discussing these things online also feels much safer than having a more personal offline discussion, even if that means experiencing more offence. It's much easier to escape if it does become too much, for one thing!
@Pomona , it's a fair cop: the answer to the simple question is 'no' I don't have any sources. My 40 years working in the NHS suggests to me that precocious puberty is very rare. I think it can overlap with short stature and I was involved in the case of a boy who was particularly short and puberty blockers were considered as a help to enable his long bones to grow more before puberty 'locks' that height. But in the end no treatment was decided on and he is now an adult and his short stature is not an issue for him. One might wonder whether there are subtle social expectations involved in such a case; ie 'men are expected to be taller than women'? But I think you'll agree medications shouldn't be used just to manage perceived problems with social expectations.
Apart from the above, forgive me but I'm out of my depth here.
Whereas in my very small circle of people who I have knowledge about medical conditions there's one who had precocious puberty treaty with puberty blockers. Which is far too small a sample to be statistically significant, and indeed I expect only those who specialise in treating adolescence and their development would have the experience necessary to give an answer to the question of how rare, or otherwise, precocious puberty is. A quick literature search produced results that aren't very clear to me, in part because there seems to be quite a bit of variation in what signs are taken to indicate the onset of puberty, and variation in how early such onset would be to be classed as "precocious". I admit I don't have the scientific background to assess the papers I found, but it does seem that precocious puberty is more common in girls, with rates of 1-5 per 1000 quite commonly quoted (some studies seem to suggest that more than 1% of girls experience precocious puberty).
@Merry Vole I'm rather puzzled by your comment to @Arethosemyfeet then. As puberty blockers are either used for precocious puberty or some other hormonal disruption in cis children or to delay puberty in trans and nonbinary children, and only one of those uses is controversial, I'm puzzled as to what bit you disagree with. Pointing out that puberty blockers are uncontroversial when used in cis children seems like a pretty neutral and factual statement to me.
With regards to short stature, stunted growth in terms of height can cause actual medical problems - particularly for joints and for exercise purposes. It's also, frankly, annoying to be short (speaking as someone who is 5'2) just for practical reasons.
@Pomona , I'll try and answer your concern. I think this tangent started when I mentioned GnRH agonists for prostate cancer after which @pease linked a paper from the American Cancer Society which discussed around a dozen 'serious side-effects' of this type of treatment in men with prostate cancer (and their partners). I then foolishly said 'no wonder their use as puberty blockers in controversial' . @Arethosemyfeet said 'only "controversial" when used for trans people. Otherwise no-one bats an eyelid'. Which I don't think is quite right. When using powerful treatments there should be a proportionality of risks and benefits. I don't think the use of puberty blockers in precocious puberty is case of 'no-one bats an eyelid'. This is what the NHS website says:
'Treatment with medication is usually only recommended if it's thought early puberty will cause emotional or physical problems, such as short height in adulthood or early periods in girls, which may cause significant distress'
GnRH agonists are also used for women with heavy bleeding due to eg fibroids or endometriosis. But only for a maximum of 6 months. Because they are powerful medications with side-effects.
And for trans children puberty blockers are obviously 'controversial' following the Hilary Cass review. Which I haven't read, and I know she is an anathema on these boards. But for all its many faults I still 'believe' in the NHS and have been sort of 'imprinted' to take heed of its governance structures eg NICE and NHS England.
I hope that sort of explains my comments up-thread.
And for trans children puberty blockers are obviously 'controversial' following the Hilary Cass review. Which I haven't read, and I know she is an anathema on these boards. But for all its many faults I still 'believe' in the NHS and have been sort of 'imprinted' to take heed of its governance structures eg NICE and NHS England.
I hope that sort of explains my comments up-thread
I'm sorry but in accepting the Cass Review they seriously let us all down on this, Merry Vole - as well as seriously harming trans youngsters.
Here's the Medical Journal of Australia explaining why the Cass Review should not be followed and how badly it is flawed
“The Cass Review, lacking expertise and compromised by implicit stigma and misinformation, does not give credible evidence‐based guidance. We are gravely concerned about its impact on the wellbeing of trans and gender‐diverse people”
They are not by a long chalk the only ones - for example the very highly rated New England Journal of Medicine has also condemned it - unfortunately that article is behind a paywall where you can't even get the full abstract but here's a newspaper summary
Was “not verified by experts”. It adds: “The review thus departed from standard practice; indeed, as mentioned above, if the US government issued a report in a similar manner, it would be violating federal law.”
“Deviates from pharmaceutical regulatory standards in the United Kingdom” and “calls for evidentiary standards for GAC that are not applied elsewhere in paediatric medicine”.
Contravenes international standards by failing to list authors. “We do know that Cass chaired the review, but observers must speculate about who else participated in the manuscript’s drafting – and whether they held bias against LGBTQ+ people”, it states.
Had a “high risk of bias according to the Risk of Bias Assessment Tool for Systematic Reviews and a ‘substandard level of scientific rigor’”.
“Improperly excluded non-English articles, ‘gray literature’ (non–peer-reviewed articles and documents), and other articles not identified by its simplistic search strategy
Professors Aaron and Konnoth wrote: “The review’s departure from the evidentiary and procedural standards of medical law, policy, and practice can be understood best in the context of the history of leveraging medicine to police gender norms.
And the same politicised approach appears to be a game the current government plans to play with neurodivergent people too - by commissioning a review from on-the-surface credentialled people who hold worrying outlier views which are not accepted as good practice in the field - presumably, one fears, to come to the conclusions ill-wishers and cost cutters in government would like to hear
Trans people today, me tomorrow, and probably you further down the line, Merry Vole, when the government thinks it can stop paying for something affecting you and yours by getting a placeman or woman with the right letters after their name to say what they want to hear but stick a pseudo- academic veneer on it, so people who trust the system will just shrug their shoulders when you're given damaging 'remedies' and have proper care banned or withheld or become the target of dangerous myths and pseudoscience.
There's a tipping point in governments and people close to them getting involved in moral panics and persecution against powerless groups and minorities when it becomes absolutely necessary to carefully scrutinise what they claim to be 'science' tying their hands - because it's very easy for people with the right contacts and credentials to pass off their nastier personally-bigoted or ignorant views as professional ones - especially when the media climate is friendly to those prejudices. We're way past that on trans people in the UK. They are a persecuted minority at the highest levels of government, media and yes, also the NHS and the courts.
And those NHS groups that dont fall into line with it, get dragged through the courts and bludgeoned by people backed by wealthy hate groups until they do.
@Merry Vole I don't see where the NHS information on GnRH agonists for early puberty suggests that their use is controversial. Nobody is demonising their use for cis children in the way that their use for trans children is demonised. To me, "nobody bats an eyelid" = "this treatment isn't controversial", not suggesting that it's a frontline treatment. Pointing out the stark difference in social attitudes towards cis children taking GnRH agonists and trans children taking GnRH agonists is not downplaying the fact that GnRH agonists aren't necessarily a frontline treatment for early puberty.
Nobody has suggested that GnRH agonists aren't powerful drugs, so I'm not quite sure why that is being brought up. All efficacious medicine has side-effects. Many very normal treatments have far more severe side-effects, such as chemotherapy - and yet nobody is creating a moral panic around chemotherapy. The existence of side-effects is not a justification for withholding treatment, otherwise very few medicines would be available to anyone. To me the use of terms like "powerful drugs" vs "effective medication" reminds me of how people talked about antidepressants and ADHD medication in the 90s - people absolutely turned those things into a moral panic, and tbh I would not be surprised if it happened again especially with ADHD medication shortages.
It is perfectly possible to appreciate what the NHS gets right and to appreciate frontline staff etc while also looking critically at NHS policies when they are harmful. For instance, it took people with ME/CFS years and years to get NICE to stop recommending treatment that actively made their condition worse - because just because medicine is a science doesn't make it free of human bias, and people with ME/CFS being stigmatised as lazy and workshy played a huge part in people being given highly inappropriate treatment. Exercise isn't any kind of drug but it still harmed people with ME/CFS due to NHS guidance.
For instance, it took people with ME/CFS years and years to get NICE to stop recommending treatment that actively made their condition worse - because just because medicine is a science doesn't make it free of human bias, and people with ME/CFS being stigmatised as lazy and workshy played a huge part in people being given highly inappropriate treatment. Exercise isn't any kind of drug but it still harmed people with ME/CFS due to NHS guidance.
@Pomona the person usually considered most responsible for these harms to people with ME/CFS is the very same person being proposed as vice chair of the new review into neurodiversity and mental health that I mention above.
It starts to seem like there's no amount of reported harm that's enough to disqualify someone if they might come to the 'desired' conclusions, save the government a bob or two and please the kind of socially conservative voters they're chasing into the bargain.
Well that's horrifying, and also really highlights how just because someone is a well-regarded scientist and/or medical professional doesn't mean that they can't be negatively biased against a particular group to the extent that they actively harm that group - particularly if they can dress up their bias as being scientifically valid. Simon Baron-Cohen and the damage done to autistic women and girls springs to mind.
Nobody has suggested that GnRH agonists aren't powerful drugs, so I'm not quite sure why that is being brought up. All efficacious medicine has side-effects. Many very normal treatments have far more severe side-effects, such as chemotherapy - and yet nobody is creating a moral panic around chemotherapy.
It strikes me that the narrative about cancer is very different to the narrative about gender identity. People with cancer are stoic sufferers, bravely battling an insidious disease. Using this kind of language to describe people who struggle with gender identity would (I suspect) seem rather strange to most us because societally acceptable attitudes to these two threats to wellbeing are vastly different.
Well, quite - the difference in social attitudes is precisely what I'm talking about. I personally wouldn't use that kind of language (about stoic sufferers bravely battling a disease) to talk about any illness because ime as a disabled and chronically ill person it's inaccurate at best - lots of people with cancer aren't stoic about it! - and putting a particular experience of an illness on a pedestal tends to make things worse for people with other illnesses.
It's also not quite true that all cancer sufferers are seen so positively - a lifelong smoker with lung cancer is seen quite differently to a generally healthy person with breast cancer. The way breast cancer in particular is both lionised and gendered has a lot of pertinent comparisons to the trans experience, particularly in terms of chest binding and top surgery.
Gender dysphoria is a medical condition and gender-affirming care - including puberty blockers for pre-pubescent trans people - is its very effective medical treatment. It's why gender-affirming surgeries aren't considered to be cosmetic surgery. It needs to be emphasised that gender-affirming care as treatment for gender dysphoria is heavily researched and has a lower dissatisfaction rate than knee replacement surgery.
@Merry Vole I don't see where the NHS information on GnRH agonists for early puberty suggests that their use is controversial. Nobody is demonising their use for cis children in the way that their use for trans children is demonised. To me, "nobody bats an eyelid" = "this treatment isn't controversial", not suggesting that it's a frontline treatment. Pointing out the stark difference in social attitudes towards cis children taking GnRH agonists and trans children taking GnRH agonists is not downplaying the fact that GnRH agonists aren't necessarily a frontline treatment for early puberty.
Nobody has suggested that GnRH agonists aren't powerful drugs, so I'm not quite sure why that is being brought up. All efficacious medicine has side-effects. Many very normal treatments have far more severe side-effects, such as chemotherapy - and yet nobody is creating a moral panic around chemotherapy. The existence of side-effects is not a justification for withholding treatment, otherwise very few medicines would be available to anyone. To me the use of terms like "powerful drugs" vs "effective medication" reminds me of how people talked about antidepressants and ADHD medication in the 90s - people absolutely turned those things into a moral panic, and tbh I would not be surprised if it happened again especially with ADHD medication shortages.
It is perfectly possible to appreciate what the NHS gets right and to appreciate frontline staff etc while also looking critically at NHS policies when they are harmful. For instance, it took people with ME/CFS years and years to get NICE to stop recommending treatment that actively made their condition worse - because just because medicine is a science doesn't make it free of human bias, and people with ME/CFS being stigmatised as lazy and workshy played a huge part in people being given highly inappropriate treatment. Exercise isn't any kind of drug but it still harmed people with ME/CFS due to NHS guidance.
You are right. 'Controversial' is the wrong word for puberty blockers in early puberty. But I suspect that different specialists would advocate different thresholds for such treatment. Because there is still a difficult judgement call between where a biological variation ends and a condition warranting medication begins. Perhaps the word 'debatable' would be nearer but I can't think of the right word right now.
Well, quite - the difference in social attitudes is precisely what I'm talking about. I personally wouldn't use that kind of language (about stoic sufferers bravely battling a disease) to talk about any illness because ime as a disabled and chronically ill person it's inaccurate at best - lots of people with cancer aren't stoic about it! - and putting a particular experience of an illness on a pedestal tends to make things worse for people with other illnesses.
Neither would I (use that kind of language) - maybe I should have used quotes. I find the idea that particular narratives apply to particular conditions unhelpful.
And some conditions seem to have a PR team working for them.
It needs to be emphasised that gender-affirming care as treatment for gender dysphoria is heavily researched and has a lower dissatisfaction rate than knee replacement surgery.
Messaging along these more informational lines is the kind of thing that seems helpful to me.
@Merry Vole I don't see where the NHS information on GnRH agonists for early puberty suggests that their use is controversial. Nobody is demonising their use for cis children in the way that their use for trans children is demonised. To me, "nobody bats an eyelid" = "this treatment isn't controversial", not suggesting that it's a frontline treatment. Pointing out the stark difference in social attitudes towards cis children taking GnRH agonists and trans children taking GnRH agonists is not downplaying the fact that GnRH agonists aren't necessarily a frontline treatment for early puberty.
Nobody has suggested that GnRH agonists aren't powerful drugs, so I'm not quite sure why that is being brought up. All efficacious medicine has side-effects. Many very normal treatments have far more severe side-effects, such as chemotherapy - and yet nobody is creating a moral panic around chemotherapy. The existence of side-effects is not a justification for withholding treatment, otherwise very few medicines would be available to anyone. To me the use of terms like "powerful drugs" vs "effective medication" reminds me of how people talked about antidepressants and ADHD medication in the 90s - people absolutely turned those things into a moral panic, and tbh I would not be surprised if it happened again especially with ADHD medication shortages.
It is perfectly possible to appreciate what the NHS gets right and to appreciate frontline staff etc while also looking critically at NHS policies when they are harmful. For instance, it took people with ME/CFS years and years to get NICE to stop recommending treatment that actively made their condition worse - because just because medicine is a science doesn't make it free of human bias, and people with ME/CFS being stigmatised as lazy and workshy played a huge part in people being given highly inappropriate treatment. Exercise isn't any kind of drug but it still harmed people with ME/CFS due to NHS guidance.
You are right. 'Controversial' is the wrong word for puberty blockers in early puberty. But I suspect that different specialists would advocate different thresholds for such treatment. Because there is still a difficult judgement call between where a biological variation ends and a condition warranting medication begins. Perhaps the word 'debatable' would be nearer but I can't think of the right word right now.
That's the entire point, though. The appropriateness of particular treatments can be matters of professional disagreement. "Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
@Merry Vole I don't see where the NHS information on GnRH agonists for early puberty suggests that their use is controversial. Nobody is demonising their use for cis children in the way that their use for trans children is demonised. To me, "nobody bats an eyelid" = "this treatment isn't controversial", not suggesting that it's a frontline treatment. Pointing out the stark difference in social attitudes towards cis children taking GnRH agonists and trans children taking GnRH agonists is not downplaying the fact that GnRH agonists aren't necessarily a frontline treatment for early puberty.
Nobody has suggested that GnRH agonists aren't powerful drugs, so I'm not quite sure why that is being brought up. All efficacious medicine has side-effects. Many very normal treatments have far more severe side-effects, such as chemotherapy - and yet nobody is creating a moral panic around chemotherapy. The existence of side-effects is not a justification for withholding treatment, otherwise very few medicines would be available to anyone. To me the use of terms like "powerful drugs" vs "effective medication" reminds me of how people talked about antidepressants and ADHD medication in the 90s - people absolutely turned those things into a moral panic, and tbh I would not be surprised if it happened again especially with ADHD medication shortages.
It is perfectly possible to appreciate what the NHS gets right and to appreciate frontline staff etc while also looking critically at NHS policies when they are harmful. For instance, it took people with ME/CFS years and years to get NICE to stop recommending treatment that actively made their condition worse - because just because medicine is a science doesn't make it free of human bias, and people with ME/CFS being stigmatised as lazy and workshy played a huge part in people being given highly inappropriate treatment. Exercise isn't any kind of drug but it still harmed people with ME/CFS due to NHS guidance.
You are right. 'Controversial' is the wrong word for puberty blockers in early puberty. But I suspect that different specialists would advocate different thresholds for such treatment. Because there is still a difficult judgement call between where a biological variation ends and a condition warranting medication begins. Perhaps the word 'debatable' would be nearer but I can't think of the right word right now.
That's the entire point, though. The appropriateness of particular treatments can be matters of professional disagreement. "Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Doctors routinely discuss what would be the appropriate treatment for some condition. It's not unusual for someone to seek a second opinion from another medical expert, and it would be unusual for anyone to say that such disagreements are in any way "controversial", in many cases those discussions weighing pro's and con's of particular treatment options is what's needed to choose the best option.
Treatment decisions only get labelled "controversial" when people without relevant medical expertise decide that a particular treatment option is not appropriate based on political expediency (eg: pandering to a particular segment of the electorate) or philosophical positions - or there can be controversy when a treatment is denied because of cost.
The appropriateness of particular treatments can be matters of professional disagreement. "Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Matters of professional disagreement can rise to the level of controversy. Chiropractors in the US had to bring a federal anti-trust suit against the American Medical Association in order for MDs to be able to refer patients to chiropractors. My dad, a radiologist, hated chiropractors, thinking they were quacks and frauds. Now chiropractic is covered by Medicare.
The appropriateness of particular treatments can be matters of professional disagreement. "Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Matters of professional disagreement can rise to the level of controversy. Chiropractors in the US had to bring a federal anti-trust suit against the American Medical Association in order for MDs to be able to refer patients to chiropractors. My dad, a radiologist, hated chiropractors, thinking they were quacks and frauds. Now chiropractic is covered by Medicare.
I would argue that chiropracty isn't a professional disagreement because chiropractors are not professionals, any more than homeopaths are. It's controversial because it's bollocks, like Gerson therapy.
The appropriateness of particular treatments can be matters of professional disagreement. "Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Matters of professional disagreement can rise to the level of controversy. Chiropractors in the US had to bring a federal anti-trust suit against the American Medical Association in order for MDs to be able to refer patients to chiropractors. My dad, a radiologist, hated chiropractors, thinking they were quacks and frauds. Now chiropractic is covered by Medicare.
I would argue that chiropracty isn't a professional disagreement because chiropractors are not professionals, any more than homeopaths are. It's controversial because it's bollocks, like Gerson therapy.
That seems a losing argument to me. Many think religion in general and Christianity in particular are bullocks. But would that mean clergy are not professionals?
That you think chiropractic is bullocks is rather irrelevant to the question of whether chiropractors are professionals. I can see no basis for denying they are professionals. They have specialized training, and in the US at least, they are licensed by the state and their services are covered by Medicare and by private insurance. And as far as that goes, I’ve known some physicians to refer patients to chiropractors for certain services.
One may think their profession is bullocks, but they are professionals.
I think it's controversial because it falls under the category I mentioned of "people without relevant medical expertise" basing decisions about treatment on philosophical positions.
The appropriateness of particular treatments can be matters of professional disagreement. "Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Matters of professional disagreement can rise to the level of controversy. Chiropractors in the US had to bring a federal anti-trust suit against the American Medical Association in order for MDs to be able to refer patients to chiropractors. My dad, a radiologist, hated chiropractors, thinking they were quacks and frauds. Now chiropractic is covered by Medicare.
I would argue that chiropracty isn't a professional disagreement because chiropractors are not professionals, any more than homeopaths are. It's controversial because it's bollocks, like Gerson therapy.
That seems a losing argument to me. Many think religion in general and Christianity in particular are bullocks. But would that mean clergy are not professionals?
That you think chiropractic is bullocks is rather irrelevant to the question of whether chiropractors are professionals. I can see no basis for denying they are professionals. They have specialized training, and in the US at least, they are licensed by the state and their services are covered by Medicare and by private insurance. And as far as that goes, I’ve known some physicians to refer patients to chiropractors for certain services.
One may think their profession is bullocks, but they are professionals.
I think if the government were in the business of licensing preachers, the analogy to religion would make more sense.
As it is, I don't think you need state license to set up a "church," at least in the USA. There's no "preaching license." If I wanted to buy a storefront and set myself up as a preacher, I could do that.
I cannot do the same thing with a medical practice, at least for now, though we'll see how much damage the current administration can do.
The appropriateness of particular treatments can be matters of professional disagreement. "Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Matters of professional disagreement can rise to the level of controversy. Chiropractors in the US had to bring a federal anti-trust suit against the American Medical Association in order for MDs to be able to refer patients to chiropractors. My dad, a radiologist, hated chiropractors, thinking they were quacks and frauds. Now chiropractic is covered by Medicare.
I would argue that chiropracty isn't a professional disagreement because chiropractors are not professionals, any more than homeopaths are. It's controversial because it's bollocks, like Gerson therapy.
That seems a losing argument to me. Many think religion in general and Christianity in particular are bullocks. But would that mean clergy are not professionals?
That you think chiropractic is bullocks is rather irrelevant to the question of whether chiropractors are professionals. I can see no basis for denying they are professionals. They have specialized training, and in the US at least, they are licensed by the state and their services are covered by Medicare and by private insurance. And as far as that goes, I’ve known some physicians to refer patients to chiropractors for certain services.
One may think their profession is bullocks, but they are professionals.
I think if the government were in the business of licensing preachers, the analogy to religion would make more sense.
I think for the assertion I was responding to—which was essentially “they’re not professionals because I think what they do is bullocks”—the analogy works just fine.
The appropriateness of particular treatments can be matters of professional disagreement. "Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Matters of professional disagreement can rise to the level of controversy. Chiropractors in the US had to bring a federal anti-trust suit against the American Medical Association in order for MDs to be able to refer patients to chiropractors. My dad, a radiologist, hated chiropractors, thinking they were quacks and frauds. Now chiropractic is covered by Medicare.
I would argue that chiropracty isn't a professional disagreement because chiropractors are not professionals, any more than homeopaths are. It's controversial because it's bollocks, like Gerson therapy.
That seems a losing argument to me. Many think religion in general and Christianity in particular are bullocks. But would that mean clergy are not professionals?
That you think chiropractic is bullocks is rather irrelevant to the question of whether chiropractors are professionals. I can see no basis for denying they are professionals. They have specialized training, and in the US at least, they are licensed by the state and their services are covered by Medicare and by private insurance. And as far as that goes, I’ve known some physicians to refer patients to chiropractors for certain services.
One may think their profession is bullocks, but they are professionals.
I think if the government were in the business of licensing preachers, the analogy to religion would make more sense.
I think for the assertion I was responding to—which was essentially “they’re not professionals because I think what they do is bullocks”—the analogy works just fine.
The difference is we're talking about medical treatment and people with actual medical training who've done research say... it's bollocks. That the charlatans managed to force US healthcare providers to pay for it through legal chicanery doesn't alter that fact or put them on a professional level with doctors or physiotherapists.
Ha! That’s what I get for posting when it late and I’m tired. (And when I’m an American who pretty much only encounters “bollocks” on the Ship.)
@Arethosemyfeet, you can think what you will, of course, but your opinion isn’t what makes something a “profession” or not.
I do find myself wondering if chiropractic is in someway different in the UK. As @ruth said, physicians and chiropractors have resolved their differences, and as I said, I’ve known physicians who refer people to chiropractors in certain instances.
My expectation was that with little evidence of genuine medical benefits, chiropractic would be widely dismissed. It appears that the NHS does accept chiropractic for treatment of lower back pain, which is much more positive in relation to quackery than I expected.
The "theory" behind chiropracty is nonsense on stilts. There is some, weak evidence that spinal manipulation may coincidentally help lower back pain, in much the same way that the sip of sugar water might make a diabetic feel better after a visit to the homeopath.
The "theory" behind chiropracty is nonsense on stilts. There is some, weak evidence that spinal manipulation may coincidentally help lower back pain, in much the same way that the sip of sugar water might make a diabetic feel better after a visit to the homeopath.
It's also based on information that the founder got from ghosts.
The NHS has depressing form for accepting quackery, alas - it's cheap.
The "theory" behind chiropracty is nonsense on stilts. There is some, weak evidence that spinal manipulation may coincidentally help lower back pain, in much the same way that the sip of sugar water might make a diabetic feel better after a visit to the homeopath.
It's also based on information that the founder got from ghosts.
The NHS has depressing form for accepting quackery, alas - it's cheap.
Part of it is the phenomenon of the "Worried Well". There's also an acronym I've heard - TEETH - "Tried Everything Else - Try Homeopathy".
I noticed one of the GP surgeries we support had a Homeopath on their staff. I was surprised they needed someone just to look after the water dispenser.
For someone who's basically well, a bit of water where any active ingredients have been diluted to non-existence isn't going to do any harm. Having someone with more time than the GP to listen to someone could be just what's needed, with a bit of "I'm taking something" placebo.
"Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Controversy in medicine may arise due to causes other than bad actors. Categorizing homosexuality as a mental health disorder became controversial because of the work of activists and increased attention to research done by people like Kinsey that the medical community had discounted due to historic prejudice against gay people. Circumcising male infants is controversial because medical science runs up against cultural factors. ME/CFS is controversial in part for medical reasons -- there isn't agreement about what to call it, what causes it, if it's psychosocial to some degree, or how to treat it. Medically assisted death is not controversial simply because of "bad actors" but because of complex moral issues.
"Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Controversy in medicine may arise due to causes other than bad actors. Categorizing homosexuality as a mental health disorder became controversial because of the work of activists and increased attention to research done by people like Kinsey that the medical community had discounted due to historic prejudice against gay people. Circumcising male infants is controversial because medical science runs up against cultural factors. ME/CFS is controversial in part for medical reasons -- there isn't agreement about what to call it, what causes it, if it's psychosocial to some degree, or how to treat it. Medically assisted death is not controversial simply because of "bad actors" but because of complex moral issues.
Fair points, though the heat generated only tends to reach a boil when fanned by bad actors.
"Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
Controversy in medicine may arise due to causes other than bad actors. Categorizing homosexuality as a mental health disorder became controversial because of the work of activists and increased attention to research done by people like Kinsey that the medical community had discounted due to historic prejudice against gay people. Circumcising male infants is controversial because medical science runs up against cultural factors. ME/CFS is controversial in part for medical reasons -- there isn't agreement about what to call it, what causes it, if it's psychosocial to some degree, or how to treat it. Medically assisted death is not controversial simply because of "bad actors" but because of complex moral issues.
Fair points, though the heat generated only tends to reach a boil when fanned by bad actors.
I think many people with strong views on that (and on many things) would bring a lot of heat to the subject, and not from being "bad actors." It might come to a boil because people are fighting for or against something they consider a very big deal indeed.
Controversy in medicine may arise due to causes other than bad actors. Categorizing homosexuality as a mental health disorder became controversial because of the work of activists and increased attention to research done by people like Kinsey that the medical community had discounted due to historic prejudice against gay people. Circumcising male infants is controversial because medical science runs up against cultural factors. ME/CFS is controversial in part for medical reasons -- there isn't agreement about what to call it, what causes it, if it's psychosocial to some degree, or how to treat it. Medically assisted death is not controversial simply because of "bad actors" but because of complex moral issues.
Earlier I'd said that IMO controversy in medicine arises when people other than qualified medical staff get involved in medical decisions, based on philosophical views or political expediency. I think I need to expand on that, to include things like prejudice prevalent in society, which qualified medics aren't going to be immune from being influenced by. And, to clarify that these controversies also include qualified medics, who may be acting either in a professional role or as an informed member of the public (eg: in discussions on assisted death doctors who specialise in end of life care have important input to the discussion, that could be based on their professional experience but could also be based on their personal religious or philosophical beliefs).
I think all of your examples include factors external to purely medical discussion. In three of those you even mention those external factors - prejudice against gay people, cultural factors, and complex moral issues.
Insulin is a powerful drug - and is also a form of hormone replacement therapy, just not sex hormone replacement therapy). Nobody uses this kind of tabloid-esque language to describe insulin. However, people do use this kind of language in talking about GLP-1 drugs (Ozempic etc) and it hasn't been lost on me that the rhetoric around weight loss medication ramped up once the puberty blocker issue was at least temporarily off the table.
I suspect there's a strong tabloid-esque bias in favour of things that are seen as restoring "normal function".
The human body normally produces insulin. Diabetics may not make enough insulin to regulate their blood sugar, or may have a resistance to the insulin they produce, and so injecting insulin looks like a way of restoring normal body performance.
By contrast, the use of puberty blockers in trans kids, or GLP-1 receptor agonists in fat people, are both attempts to subvert the body's normal functioning in order to generate a desired outcome (the trans kid doesn't want to go through the normal puberty process associated with the body they have; the fat person wants to lose weight).
The tabloid prejudice against GLP-1 RAs centres on their use by fat people who want to be thin people, and not by diabetics who use them as a tool to help manage their condition.
I think this is giving tabloid prejudice a bit too much credit for thinking consistently about anything. Trans people and people who do not fit majority body standards are both scapegoated groups who get attacked - with a lot of it stemming from wanting to control women's bodies and to punish those who transgress patriarchal gender norms or who are seen to be 'cheating' by finding an 'easy' way to escape harsh gender norms.
Comments
Yes, they (LHRH agonists - usually in the UK known as GnRH agonists) are powerful drugs. No wonder their use as puberty blockers is controversial.
It's only "controversial" when used to treat trans people. No-one bats an eyelid otherwise.
I think we'll have to disagree about that on another thread!
But it is a fact. Using puberty blockers is not at all controversial when it comes to treating precocious puberty. That is their other use. Do you have any sources saying that using puberty blockers to treat precocious puberty is controversial?
Insulin is a powerful drug - and is also a form of hormone replacement therapy, just not sex hormone replacement therapy). Nobody uses this kind of tabloid-esque language to describe insulin. However, people do use this kind of language in talking about GLP-1 drugs (Ozempic etc) and it hasn't been lost on me that the rhetoric around weight loss medication ramped up once the puberty blocker issue was at least temporarily off the table.
In a previous life I wanted to explore the theology of eunuchs in the Bible as the intersection of gender and disability, and I think this thread is demonstrating why disability and gender are so linked to discussions of eunuchs. It very much seems to be a discussion about Good Bodies and Bad Bodies (and Good Marginalised People and Bad Marginalised People) - and I had forgotten until just now that fatness was very much part of the historical eunuch stereotype, so really coming full-circle with GLP-1 medication taking the place of puberty blockers in the tabloids (for the avoidance of doubt, I am a fat person who has been involved in fat activism since my teens, as well as trans and disabled).
I think cis people being able to have gender affirming surgery and destigmatising it is a good thing. I don't think that painting self-identifying eunuchs that desire an orchiectomy as being responsible for trans people having fewer rights is helpful to trans people - the people at fault are transphobes, not NHS Scotland being too inclusive. I don't have an issue with a cis man getting an elective orchiectomy, it's their body and it doesn't affect me. Cis people can have gender dysphoria too, likewise not all trans people do have gender dysphoria.
I actually think that the type of discussion I would like to have with many knowledgeable people on this thread (and with other Shipmates not currently on this thread) cannot take place on any on-line discussion forum, including on this Ship. The potential for accidently 'saying' (ie typing) something that offends or gets misunderstood is just too great -for me at least.
This thread already has a lot of 'heavy' issues and I will continue to follow it and learn a lot. But I doubt I have anything further to contribute that would be helpful.
1) not actually give a response to mine and @Arethosemyfeet 's replies - that seems like a bit of a cop-out, especially when "Do you have any sources saying that using puberty blockers to treat precocious puberty is controversial?" is a simple yes/no question;
2) frame meta discussions of disagreement within this discussion around offence or misunderstanding, when disagreement is neither of those things.
Also personally as an ND person I find online discussions MUCH less prone to misunderstanding than offline discussions, particularly as I have sensory processing issues which make taking in spoken information more difficult than taking in something I've read. For a lot of trans people - ND or not - discussing these things online also feels much safer than having a more personal offline discussion, even if that means experiencing more offence. It's much easier to escape if it does become too much, for one thing!
@Pomona , it's a fair cop: the answer to the simple question is 'no' I don't have any sources. My 40 years working in the NHS suggests to me that precocious puberty is very rare. I think it can overlap with short stature and I was involved in the case of a boy who was particularly short and puberty blockers were considered as a help to enable his long bones to grow more before puberty 'locks' that height. But in the end no treatment was decided on and he is now an adult and his short stature is not an issue for him. One might wonder whether there are subtle social expectations involved in such a case; ie 'men are expected to be taller than women'? But I think you'll agree medications shouldn't be used just to manage perceived problems with social expectations.
Apart from the above, forgive me but I'm out of my depth here.
With regards to short stature, stunted growth in terms of height can cause actual medical problems - particularly for joints and for exercise purposes. It's also, frankly, annoying to be short (speaking as someone who is 5'2) just for practical reasons.
'Treatment with medication is usually only recommended if it's thought early puberty will cause emotional or physical problems, such as short height in adulthood or early periods in girls, which may cause significant distress'
GnRH agonists are also used for women with heavy bleeding due to eg fibroids or endometriosis. But only for a maximum of 6 months. Because they are powerful medications with side-effects.
And for trans children puberty blockers are obviously 'controversial' following the Hilary Cass review. Which I haven't read, and I know she is an anathema on these boards. But for all its many faults I still 'believe' in the NHS and have been sort of 'imprinted' to take heed of its governance structures eg NICE and NHS England.
I hope that sort of explains my comments up-thread.
I'm sorry but in accepting the Cass Review they seriously let us all down on this, Merry Vole - as well as seriously harming trans youngsters.
Here's the Medical Journal of Australia explaining why the Cass Review should not be followed and how badly it is flawed
Cass Review does not guide care for trans young people
They are not by a long chalk the only ones - for example the very highly rated New England Journal of Medicine has also condemned it - unfortunately that article is behind a paywall where you can't even get the full abstract but here's a newspaper summary
https://www.thenational.scot/news/24870246.cass-review-transgresses-medical-law-policy-us-experts-claim/
In the view of the authors the Cass Review
It's been looked at and rejected internationally.
https://ruthpearce.net/2024/04/16/whats-wrong-with-the-cass-review-a-round-up-of-commentary-and-evidence/
And the same politicised approach appears to be a game the current government plans to play with neurodivergent people too - by commissioning a review from on-the-surface credentialled people who hold worrying outlier views which are not accepted as good practice in the field - presumably, one fears, to come to the conclusions ill-wishers and cost cutters in government would like to hear
https://www.benefitsandwork.co.uk/news/controversial-professor-to-investigate-overdiagnosis-of-mental-health-and-neurodivergence-for-labour
Trans people today, me tomorrow, and probably you further down the line, Merry Vole, when the government thinks it can stop paying for something affecting you and yours by getting a placeman or woman with the right letters after their name to say what they want to hear but stick a pseudo- academic veneer on it, so people who trust the system will just shrug their shoulders when you're given damaging 'remedies' and have proper care banned or withheld or become the target of dangerous myths and pseudoscience.
There's a tipping point in governments and people close to them getting involved in moral panics and persecution against powerless groups and minorities when it becomes absolutely necessary to carefully scrutinise what they claim to be 'science' tying their hands - because it's very easy for people with the right contacts and credentials to pass off their nastier personally-bigoted or ignorant views as professional ones - especially when the media climate is friendly to those prejudices. We're way past that on trans people in the UK. They are a persecuted minority at the highest levels of government, media and yes, also the NHS and the courts.
And those NHS groups that dont fall into line with it, get dragged through the courts and bludgeoned by people backed by wealthy hate groups until they do.
Nobody has suggested that GnRH agonists aren't powerful drugs, so I'm not quite sure why that is being brought up. All efficacious medicine has side-effects. Many very normal treatments have far more severe side-effects, such as chemotherapy - and yet nobody is creating a moral panic around chemotherapy. The existence of side-effects is not a justification for withholding treatment, otherwise very few medicines would be available to anyone. To me the use of terms like "powerful drugs" vs "effective medication" reminds me of how people talked about antidepressants and ADHD medication in the 90s - people absolutely turned those things into a moral panic, and tbh I would not be surprised if it happened again especially with ADHD medication shortages.
It is perfectly possible to appreciate what the NHS gets right and to appreciate frontline staff etc while also looking critically at NHS policies when they are harmful. For instance, it took people with ME/CFS years and years to get NICE to stop recommending treatment that actively made their condition worse - because just because medicine is a science doesn't make it free of human bias, and people with ME/CFS being stigmatised as lazy and workshy played a huge part in people being given highly inappropriate treatment. Exercise isn't any kind of drug but it still harmed people with ME/CFS due to NHS guidance.
@Pomona the person usually considered most responsible for these harms to people with ME/CFS is the very same person being proposed as vice chair of the new review into neurodiversity and mental health that I mention above.
It starts to seem like there's no amount of reported harm that's enough to disqualify someone if they might come to the 'desired' conclusions, save the government a bob or two and please the kind of socially conservative voters they're chasing into the bargain.
I fear we're going to get our very own scandal.
It's also not quite true that all cancer sufferers are seen so positively - a lifelong smoker with lung cancer is seen quite differently to a generally healthy person with breast cancer. The way breast cancer in particular is both lionised and gendered has a lot of pertinent comparisons to the trans experience, particularly in terms of chest binding and top surgery.
Gender dysphoria is a medical condition and gender-affirming care - including puberty blockers for pre-pubescent trans people - is its very effective medical treatment. It's why gender-affirming surgeries aren't considered to be cosmetic surgery. It needs to be emphasised that gender-affirming care as treatment for gender dysphoria is heavily researched and has a lower dissatisfaction rate than knee replacement surgery.
You are right. 'Controversial' is the wrong word for puberty blockers in early puberty. But I suspect that different specialists would advocate different thresholds for such treatment. Because there is still a difficult judgement call between where a biological variation ends and a condition warranting medication begins. Perhaps the word 'debatable' would be nearer but I can't think of the right word right now.
And some conditions seem to have a PR team working for them. Messaging along these more informational lines is the kind of thing that seems helpful to me.
That's the entire point, though. The appropriateness of particular treatments can be matters of professional disagreement. "Controversy", on the other hand, tends to only arise when bad actors want to demonise either doctors, patients or both.
I don't understand.
Treatment decisions only get labelled "controversial" when people without relevant medical expertise decide that a particular treatment option is not appropriate based on political expediency (eg: pandering to a particular segment of the electorate) or philosophical positions - or there can be controversy when a treatment is denied because of cost.
Matters of professional disagreement can rise to the level of controversy. Chiropractors in the US had to bring a federal anti-trust suit against the American Medical Association in order for MDs to be able to refer patients to chiropractors. My dad, a radiologist, hated chiropractors, thinking they were quacks and frauds. Now chiropractic is covered by Medicare.
I would argue that chiropracty isn't a professional disagreement because chiropractors are not professionals, any more than homeopaths are. It's controversial because it's bollocks, like Gerson therapy.
That you think chiropractic is bullocks is rather irrelevant to the question of whether chiropractors are professionals. I can see no basis for denying they are professionals. They have specialized training, and in the US at least, they are licensed by the state and their services are covered by Medicare and by private insurance. And as far as that goes, I’ve known some physicians to refer patients to chiropractors for certain services.
One may think their profession is bullocks, but they are professionals.
In the US it was a disagreement between medical professionals that has been resolved.
I think if the government were in the business of licensing preachers, the analogy to religion would make more sense.
As it is, I don't think you need state license to set up a "church," at least in the USA. There's no "preaching license." If I wanted to buy a storefront and set myself up as a preacher, I could do that.
I cannot do the same thing with a medical practice, at least for now, though we'll see how much damage the current administration can do.
The difference is we're talking about medical treatment and people with actual medical training who've done research say... it's bollocks. That the charlatans managed to force US healthcare providers to pay for it through legal chicanery doesn't alter that fact or put them on a professional level with doctors or physiotherapists.
@Arethosemyfeet, you can think what you will, of course, but your opinion isn’t what makes something a “profession” or not.
I do find myself wondering if chiropractic is in someway different in the UK. As @ruth said, physicians and chiropractors have resolved their differences, and as I said, I’ve known physicians who refer people to chiropractors in certain instances.
It's also based on information that the founder got from ghosts.
The NHS has depressing form for accepting quackery, alas - it's cheap.
Part of it is the phenomenon of the "Worried Well". There's also an acronym I've heard - TEETH - "Tried Everything Else - Try Homeopathy".
I noticed one of the GP surgeries we support had a Homeopath on their staff. I was surprised they needed someone just to look after the water dispenser.
Controversy in medicine may arise due to causes other than bad actors. Categorizing homosexuality as a mental health disorder became controversial because of the work of activists and increased attention to research done by people like Kinsey that the medical community had discounted due to historic prejudice against gay people. Circumcising male infants is controversial because medical science runs up against cultural factors. ME/CFS is controversial in part for medical reasons -- there isn't agreement about what to call it, what causes it, if it's psychosocial to some degree, or how to treat it. Medically assisted death is not controversial simply because of "bad actors" but because of complex moral issues.
Fair points, though the heat generated only tends to reach a boil when fanned by bad actors.
I think many people with strong views on that (and on many things) would bring a lot of heat to the subject, and not from being "bad actors." It might come to a boil because people are fighting for or against something they consider a very big deal indeed.
I think all of your examples include factors external to purely medical discussion. In three of those you even mention those external factors - prejudice against gay people, cultural factors, and complex moral issues.
I suspect there's a strong tabloid-esque bias in favour of things that are seen as restoring "normal function".
The human body normally produces insulin. Diabetics may not make enough insulin to regulate their blood sugar, or may have a resistance to the insulin they produce, and so injecting insulin looks like a way of restoring normal body performance.
By contrast, the use of puberty blockers in trans kids, or GLP-1 receptor agonists in fat people, are both attempts to subvert the body's normal functioning in order to generate a desired outcome (the trans kid doesn't want to go through the normal puberty process associated with the body they have; the fat person wants to lose weight).
The tabloid prejudice against GLP-1 RAs centres on their use by fat people who want to be thin people, and not by diabetics who use them as a tool to help manage their condition.