It's clear that some people are delighted to have had gender modifying treatments, many others show regret.

Normally in health care informed consent requires information about Numbers needed to benefit and numbers needed to harm. For gender treatments the information is not available.  Current Concerns About Gender-Affirming Therapy in Adolescents | Current Sexual Health Reports (springer.com)<https://link.springer.com/article/10.1007/s11930-023-00358-x> AND Full article: Iatrogenic Harm in Gender Medicine (tandfonline.com)<https://www.tandfonline.com/doi/full/10.1080/0092623X.2023.2224320>

Nor can parents find information about the characteristics and proportion of people who suffer from harms related to treatments-the link is to non-contentious lists of adverse effects of gender affirming care (What to Know About Gender-Affirming Hormone Therapy (alto.com)<https://www.alto.com/blog/post/transgender-hormone-therapy-side-effects> )

Adults consenting for minors are not able to obtain pertinent information about the people most likely to express delight, or disappointment following medical and surgical gender treatment.

The links, Dr. Raven's comment, and the Baxendale articles,  suggest the need for systematic research and data collection because, for now, there is insufficient information to support informed consent.

Adults should be free to consent to treatments where the chances of risk and harm are not well established.

It's different in my opinion, when someone consents on behalf of a minor.  At the least all those providing aggressive medical and surgical treatments should encourage, possibly insist, that the patients enroll in systematic long term follow up so that eventually clinicians can provide patients with the information necessary for informed consent.

Link:
Full article: Iatrogenic Harm in Gender Medicine (tandfonline.com)<https://www.tandfonline.com/doi/full/10.1080/0092623X.2023.2224320>
Current Concerns About Gender-Affirming Therapy in Adolescents | Current Sexual Health Reports (springer.com)<https://link.springer.com/article/10.1007/s11930-023-00358-x>
"The question, “Do the benefits of youth gender transitions outweigh the risks of harm?” remains unanswered because of a paucity of follow-up data.

Because the future well-being of young patients and their families is at stake, the field must stop relying on social justice arguments and return to the time-honored principles of evidence-based medicine."

________________________________
From: Social Determinants of Health <[log in to unmask]> on behalf of Dan <[log in to unmask]>
Sent: Saturday, February 24, 2024 8:15 AM
To: [log in to unmask] <[log in to unmask]>
Subject: Re: [SDOH] Baxendale (2024) The impact of suppressing puberty on neuropsychological function; Baxendale (2024) Why did three journals reject my puberty-blocker study?

CAUTION: The Sender of this email is not from within Dalhousie.
Hello,

Ignoring the fact that there are always people against the grain, let's pretend everything here is correct other than the perceived persecution of this author. We have all had papers rejected for non methodological reasons.

Does it matter that there are harms from puberty blockers? Chemotherapy does harm. Lifestyle change causes harm. Who cares if there are side effects to a treatment that these people see as life changing and beneficial? This reminds me of someone telling people who are taking up exercise that they are doing it wrong and might injure their knees.

It seems like you are very interested in this topic. With new technologies or trends there will always be a market for stories of regret or fear. The key is obviously balance between treatment, counselling, etc. Pointing to a partial equilibrium outcome and saying "See? That's bad!" just sucks the oxygen out of the room.

Dan


On Sat, Feb 24, 2024, 3:33 a.m. Melissa Raven <[log in to unmask]<mailto:[log in to unmask]>> wrote:

Hi all

'I have never encountered the kinds of concerns that some of the reviewers expressed in response to my review of puberty blockers. In this case, it wasn’t the methods they objected to, it was the actual findings.' (Baxendale 2024)

Attached are pdfs of two articles by Sallie Baxendale, a UK neuropsychologist, about puberty blockers, illustrating the (widespread) suppression of evidence about the potential harms of 'gender-affirming care':

  *   Baxendale S (2024) The impact of suppressing puberty on neuropsychological function: A review. Acta Paediatrica. 2024;00:1-12. https://doi.org/10.1111/apa.17150. (Open Access).
  *   Baxendale S (2024) Why did three journals reject my puberty-blocker study? UnHerd. https://unherd.com/2024/02/why-did-three-journals-reject-my-puberty-blocker-study/



Here is the abstract and 'Key notes' of Baxendale's review article in Acta Paediatrica:

Abstract

Aim Concerns have been raised regarding the impact of medications that interrupt puberty, given the magnitude and complexity of changes that occur in brain function and structure during this sensitive window of neurodevelopment. This review examines the literature on the impact of pubertal suppression on cognitive and behavioural function in animals and humans.

Methods All studies reporting cognitive impacts of treatment with GnRH agonists/antagonists for pubertal suppression in animals or humans were sought via a systematic search strategy across the PubMed, Embase, Web of Science and PsycINFO databases.

Results Sixteen studies were identified. In mammals, the neuropsychological impacts of puberty blockers are complex and often sex specific (n = 11 studies). There is no evidence that cognitive effects are fully reversible following discontinuation of treatment. No human studies have systematically explored the impact of these treatments on neuropsychological function with an adequate baseline and follow-up. There is some evidence of a detrimental impact of pubertal suppression on IQ in children.

Conclusion Critical questions remain unanswered regarding the nature, extent and permanence of any arrested development of cognitive function associated with puberty blockers. The impact of puberal suppression on measures of neuropsychological function is an urgent research priority.

Key notes

  *   Adolescence is a critical window of neurodevelopment and puberty plays a critical role in these neurodevelopmental processes.
  *   The suppression of puberty impacts brain structure and the development of social and cognitive functions in mammals, the effects are complex and often sex specific.
  *   No human studies have systematically explored the neuropsychological impact of pubertal suppression in transgender adolescents with an adequate baseline and follow-up, this is an urgent research priority.



Baxendale's commentary article in UnHerd includes:

Last year, I wrote a paper [that] explained in relatively simple terms why we might think that blocking puberty in young people could impact their cognitive development. In a nutshell: puberty doesn’t just trigger the development of secondary sex characteristics; it is a really important time in the development of brain function and structure. My review of the medical literature highlighted that while there is a fairly solid scientific basis to suspect that any process that interrupts puberty will have an impact on brain development, nobody has really bothered to look at this properly in children with gender dysphoria.

…

I was surprised at just how little, and how low quality, the evidence was in this field. I was also concerned that clinicians working in gender medicine continue to describe the impacts of puberty blockers as “completely physically reversible”, when it is clear that we just don’t know whether this is the case, at least with respect to the cognitive impact.

…

The paper has now been accepted for publication in a well-respected, peer-reviewed journal. However, prior to this, the manuscript was submitted to three academic journals, all of whom rejected it.

… I have never encountered the kinds of concerns that some of the reviewers expressed in response to my review of puberty blockers. In this case, it wasn’t the methods they objected to, it was the actual findings.

… the most astonishing response I received was from a reviewer who was concerned that I appeared to be approaching the topic from a “bias” of heavy caution. This reviewer argued that lots of things needed to be sorted out before a clear case for the “riskiness” of puberty blockers could be made, even circumstantially. Indeed, they appeared to be advocating for a default position of assuming medical treatments are safe, until proven otherwise.



This sort of academic capture is part of a much broader regulatory/institutional capture that is strongly suppressing evidence/discussion/debate about gender-affirming care and gender identity/ideology.



Regards

Melissa



Melissa Raven

MPsych(Clin) MMedSc(ClinEpid) PhD

Psychiatric epidemiologist and policy analyst

Research Fellow

Critical and Ethical Mental Health<https://www.adelaide.edu.au/robinson-research-institute/critical-and-ethical-mental-health/> research group (CEMH)

www.adelaide.edu.au/robinson-research-institute/research/groups/cemh/<http://www.adelaide.edu.au/robinson-research-institute/research/groups/cemh/>

Robinson Research Institute

Faculty of Health and Medical Sciences

University of Adelaide

55 King William Road, North Adelaide SA 5006, AUSTRALIA

PhD: Depression and antidepressants in Australia and beyond - a critical public health analysis https://ro.uow.edu.au/theses/3686/



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