Thread by @BayswaterSG

An outdated and flawed report on "Hormone treatments for children and young people with gender dysphoria" is referenced in briefing materials for parliamentarians ahead of Monday's debate on the PATHWAYS puberty blocker trial.
commonslibrary.parliament.uk/research-brief…

This POST report was poor at the time of publication (November 2023) but is now outright misleading in several ways. It should not be relied on for information in this area.
researchbriefings.files.parliament.uk/documents/POST…

A summary of the key shortcomings ...
1/8

2/8 The report presents misleading claims about puberty blockers being "time to think" without spelling out the lack of evidence for this thesis (the HRA explicitly warned GIDS against making this claim as early as 2019).

3/8 GIDS is presented in the report as having "relevant expertise", yet a CQC report in 2021 (2 years before the POST briefing) found GIDS to be ‘inadequate’ overall, ‘inadequate’ in leadership, ‘inadequate’ in responsiveness to people's needs, and ‘requires improvement’ in safety and effectiveness.

4/8 GIDS was already scheduled to close at the time the POST report was written and its failings were well-documented (not least during the 2020 Keira Bell case). None of this is reflected in the report. The decision to roll out puberty blockers as "routine clinical practice" in 2014 is mentioned without explaining that this was done before the GIDS PB trial had concluded and without evidence to support this decision.

5/8 The report cites the claim that "allowing natural puberty to progress may increase distress and harm psychological wellbeing" as if this is an authoritative statement. Similarly the "expert" opinion that puberty blockers are "physically reversible" is only weakly countered with an acknowledgement of "uncertainties". Neither detransition nor desistance warrant a mention in the report.

6/8 The report states that clinical practice is based on WPATH and the Endocrine Society guidelines and it links to both organisations. Even at the time the report was written, the NHS had explicitly distanced itself from these groups and had removed WPATH references from the paediatric specification. Since the POST report was written, the WPATH and Endocrine Society guidelines were rated poorly in the final Cass Review: lacking "developmental rigour" and "editorial independence" (engaging in circular cross-referencing).

7/8 Several of the footnotes in the report link to citations that do not support the relevant claim being made. Simple errors are made, such as that the NICE review rated evidence as "low quality" when in fact the GRADE rating was "very low" (an important distinction as this is a separate quality category).

8/8 Finally, the POST report specifically highlights critical responses to the interim Cass Review from Stonewall and Mermaids, but fails to mention in the main text that many stakeholders were already aware that the interim report represented a first step to restoring safe and effective care for these children.

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