Feb 2Liked by Bernard Lane

The extraordinarily unscientific and irresponsible approach of some of these clinicians seen in their statements which could be summarised as: "We know it works because we say it works" and "We can't do any more research because kids are desperate for these treatments" is breathtaking.

Then there are the unsupportable rationalisations used to justify the study in the first place: "It seems possible to select patients who will profit from early interventions". On the basis of a mere possibility clinicians were willing to experiment on children in ways that (they should have been able to foresee) would foreclose their future development, sexual function and fertility?

Similarly gobsmacking is the unconvincing "trust us" style protestations such as: "In case of any signs of negative effects ... we would have ended the protocol". Given that the negative effects were and remain largely unknown (though it's becoming clearer there are multiple, severe negative effects) how could they possibly have been monitoring adequately for them? There's also a glaring absence of any acknowledgement by the researchers that these procedures were (and are) experimental.

Arguing that children won't be able to make a "balanced" decision if not given the treatments because all their energy will be focused on obtaining such treatment is like arguing that teenage heroin addicts should be given heroin because otherwise they'll just be distracted by the desperate search for supplies of it, so how could they possibly make their mind up about their future?

Then of course there's the now standard argument that blockers give kids "time" to make up their mind, which completely ignores the reality that by blocking puberty, clinicians are preventing kids from undergoing a natural developmental stage which in the vast majority of cases in itself assists in the resolution of gender dysphoria. As we know from Dr Ken Zucker's work, something like 88% of kids with GD came to accept their sex if allowed to go through puberty. Giving puberty blockers unavoidably inculcates a fear of puberty and a belief that it's "wrong" for the patient to undergo such an "horrific" process, rather than normalising it as a natural maturational process. It's no wonder that practically all kids on PBs progress on to wrong sex hormones. Administering PBs amounts to a determination that the child is "trans" or "non binary" and must therefore continue along on the trans treatment train.

To add fuel to the fire, most outrageously, for them to assert that they—in contrast to ordinary mortals throughout history—are incorruptible is an insult to our intelligence. Of course this seduction by the pharmaceutical industry is a problem throughout medicine but that does not excuse this absurd claim. Everyone is corruptible, and the corruption often occurs unconsciously. Studies have shown that doctors can be powerfully influenced by attractive female drug reps in skimpy outfits, and by gifts as insignificant as a pen with the name of a drug on it. Similarly, medicos' belief in a treatment (and arguably, warm fuzzy feelings about a generous pharmaceutical benefactor) can influence the patient's experience of treatments without the clinician needing to say a word about it. In other words, it's communicated through body language, tone of voice and facial expression, hence the need for "double blind trials". So suggesting that something as crucial and significant as funding researcher positions doesn't alter the results of studies beggars belief.

We need a return to the Watchful Waiting with psychotherapeutic support approach to gender dysphoria. People can follow us on: https://www.facebook.com/WatchfulWaitingOz

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This whole area reminds me of a similar situation in my field of oncology.

In the late 80’s and 90’s High dose Chemotherapy with stem cell rescue was promoted as a treatment for Breast Cancer. It made sense. This treatment was successful in Testicular Cancer and Lymphoma. Why wouldn’t it be successful in Breast Cancer. However there was a lack of randomised studies until one was published by Dr Bezwoda in South Africa which was reported as highly positive. On the basis of this study Insurance Companies in the USA started to pay for the treatment.

Unfortunately after an audit of Bezwoda’s work in 1999 his study was found to be fraudulent. Subsequent randomised studies found no advantage for the treatment and substantial toxicity. The treatment was subsequently denied funding.

I do not suggest fraud in the Dutch studies but note the similar amount of enthusiasm by followers of the Dutch study for an unproven treatment and similar arguments against randomized studies.

And remember the Oncologists who were treating Breast Cancer were treating patients with a deadly disease.

In the case of gender dysphoric children we are treating physically normal children and putting them on a possible pathway of irreversible mutilating surgery.

I believe the only way these children should be treated is in a proper randomized placebo controlled trial. It may not be possible to blind the study completely.

Ethics Committees need to step up and demand that all ad hoc treatment cease until such trials show a benefit.

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It reads as a heroic study of a rapidly evolving brave new clinical intervention for children and young people suffering from a debilitating life-threatening gender mismatch.

Generous drug companies came to the party providing the magic potion and a supply of cash to assist with monitoring.

The outcomes for recipients has been life changing/saving and there have been virtually no downsides and no suggestion of conflict of interest.

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