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SEGM

@segm_ebm

Apr 11

We've completed our preliminary analysis of the Cass Report. The "gender-affirming" model of care is over in England, as is the era of the gender-clinic model of care, which exists to deliver youth transitions. This will have world-wide implications./1

segm.org/Final-Cass-Rep…

Puberty blockers will no longer be part of medical care in England. Cross-sex hormones are still available to 16+, but with "extreme caution," external validation of medical necessity, & further policy restrictions are likely. Systematic reviews support these recommendations. /2

Gender-transition surgeries for <18s have never been allowed in England, so no systematic reviews of surgeries for youth have been conducted and no policy changes are needed. /3

Read 13 tweets

SEGM

@segm_ebm

Apr 8

Last week, England shut down the world’s largest pediatric gender clinic at the Tavistock (GIDS). Investigative journalist Hannah Barnes shares 7 lessons for the rest of the world at @segm_ebm NYC conference.
Lesson 1: When new evidence emerges, be prepared to change direction.

By now, the science in the area of gender medicine is widely recognized as “unsettled” due to poor study designs—but this was known from the start. This is why the UK gender clinic initiated its own research in 2011. But instead of waiting for research results, the clinic began to widely offer gender transitions to all youth who desired it.

This pattern of the gender-affirming interventions "escaping the lab" before the benefits and the harms were fully understood (known as "runaway diffusion") occurred not just in the UK, but also in the rest of the world.

Some speculate that it was the pressure to "keep up with the Dutch." Others note the role of special interest groups in creating undue pressure on clinicians. Yet others believe it was simply the case of a “well-meaning but ill-informed” approach. /1

At the same time as youth gender transitions became widely available, the numbers of referred gender distressed youth began to rapidly grow. Unexpectedly, the profile shifted from mostly young boys, to mostly adolescent females with serious mental health problems.

It was clear from the start that the young patients presenting with gender distress were far more complex than the cases described in the Dutch protocol. This did not deter gender clinicians, who asserted every child who wanted to medically gender transition should be assisted in doing so, regardless of their mental illness or other complexities. /2

By 2016, the UK gender clinic had enough outcome data to observe two problematic results. Contrary to the expectation, the kids were NOT doing better psychologically on puberty blockers, and some even got worse. These data remained unpublished for 5 years, as more and more children continued to receive these interventions. /3

Read 14 tweets

SEGM

@segm_ebm

Apr 4

A new publication concludes that puberty blockers for gender dysphoria undermine a child’s right to an open future, a bioethics principle stating that children must be protected from exercising certain rights to exercise these rights as autonomous adults./1
segm.org/puberty-blocke…

The authors "evaluate claims that puberty blockers are reversible, discuss the scientific uncertainty about long-term benefits and harms, summarize international developments, and examine how suicide has been used to frame puberty suppression as a medically necessary, lifesaving treatment."

They conclude that "treatment pathways that delay decisions about medical transition until the child has had the chance to grow and mature into an autonomous adulthood would be most consistent with the open future principle." /2

The authors note that under the gender-affirming care framework, a normal physiological process of puberty is viewed as a disease that must be treated with endocrine and surgical treatments. The use of puberty blockers, the first step in this "cascade" of interventions, rests on two assumptions: "(1) puberty blockers are a low-risk, reversible intervention, and (2) suppressing puberty will improve physical and psychological outcomes in later life."

The authors examine these assumptions and find them to be unsupported by the evidence. Puberty blockers are associated with substantial harms and profound unknowns (e.g., bone, brain, fertility, and sexual function harms), and there is no compelling evidence that they improve psychological outcomes.
/3

Read 5 tweets

SEGM

@segm_ebm

Mar 21

Dr. Kaltiala just won Finland's most prestigious medical award for her work in adolescent psychiatry. Dr. Kaltiala was a speaker at @segm_ebm's NYC conference, where she described how the Finnish youth gender services moved away from the "gender-affirmative" model of care. 🎉/1

In her acceptance speech, Dr. Kaltiala discussed how current cultural trends undermine healthy adolescent development. "The slow development towards the authentic self turns into a lightning-fast self-presentation on social-media forums that are always under observation."

Dr. Kaltiala observed that "a stable, developed identity enables an individual to have a permanent self-experience from one situation and life stage to another, as well as to maintain a sense of permanence and psychological ability to function even in the face of adversity." She noted that "too much focus on the individual and individuality disconnects from stabilizing communities and shared realities." /2

laakarilehti.fi/terveydenhuolt…

Dr. Kaltiala pointed out that general identity development and gender identity development challenges are intertwined and that a rush to permanent medicalization is not consistent with the principles of adolescent identity development.

While the Google-translated announcement of the award got a few words wrong (and misgendered Dr. Kaltiala in the process), the translation still conveys the key points.

/3laakarilehti.fi/terveydenhuolt…

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SEGM

@segm_ebm

Mar 15

The @NHSEngland landmark decision to stop using puberty blockers for gender dysphoric youth raises a key question: what do we know about the effects of puberty blockers on adolescent development?
Prof. Sallie Baxendale explored this question at @segm_ebm 2023 conference./1🧵

"Extraordinary claims demand extraordinary evidence" wrote Prof. Baxendale in a piece describing her research. "The only extraordinary evidence here is the gaping chasm of knowledge, or even apparent curiosity, of the clinicians who continue to chant 'safe and completely reversible' as they prescribe these medications to the children in their care." /2
unherd.com/2024/02/why-di…

Following the preview of her research at @segm_ebm conference, Prof. Baxendale published her findings about the known effects of puberty blockers
on neuropsychological function in a peer-reviewed journal.

Prof. Baxendale later shared that in her 3 decades of academic publishing, the submission of the paper was truly a unique experience. She was not concerned that the paper had been rejected 3 times prior to being accepted. Rather, it was the nature of the rejections, which appeared to be ideologically driven. /3
onlinelibrary.wiley.com/doi/full/10.11…

Read 13 tweets

SEGM

@segm_ebm

Mar 3

Canada's public broadcaster aired a new documentary, Trans Express, underscoring the growing international concern with the practice of youth gender transitions. SEGM's NYC 2023 conference was profiled. /1

Full documentary (in French):
Synopsis (in French, but can be google-translated): ici.tou.tv/enquete
ici.radio-canada.ca/recit-numeriqu…

The documentary interviewed several speakers from SEGM's NYC 2023 conference, including Drs. Anderson, Kaltiala, Landen, Littman, and Veissiere. /2

segm.org/NYC_2023

Dr. Littman was asked about her research into the surge in adolescent girls with no history of childhood gender dysphoria. Her research suggested a significant role of social influence and need for caution. /3

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