The US "paper of record" @nytimes covered puberty blockers on the front page yesterday. A milestone. Time for a ๐งต looking at the coverage, and look back on the year's other developments in this space.
1/
1/
First, the framing that "transgender youths" are taking these drugs. But really its any kid, often proto-LGB, who is distressed by their body or imposed stereotypes and latches onto an identity (as kids do) to feel connected to a community
2/
archive.ph
2/
archive.ph
We know that they're not being assessed and treatments are initiated based on the child's demand and parent's agreement (after they're told their child risks suicide)
This was highlighted in the @Reuters report last month (another milestone)
3/
reuters.com
This was highlighted in the @Reuters report last month (another milestone)
3/
reuters.com
In NZ, guidelines go as far as *discouraging* assessment. I have an OIA response (2021) from @minhealthnz where they discuss clarifying that to further discourage *any* assessment before the kid is treated with blockers
4/
4/
No-one has demonstrated mental health benefits in a trial. And its unsurprising that a kid, anxious about approaching puberty, is relieved when told that its gone away (placebo)
5/
5/
Everyone was anxious about puberty! How to distinguish between this and supposedly distinct trans anxiety?
puberty anxiety + gender nonconforming + don't want to be a woman? Must be trans!
(but describes many young lesbians; explains why โ๏ธ on blockers have shot up)
/6
puberty anxiety + gender nonconforming + don't want to be a woman? Must be trans!
(but describes many young lesbians; explains why โ๏ธ on blockers have shot up)
/6
The Times piece focuses on bone health impacts. Reasonable as there's some research and easy to quantify (bone scan).
7/
7/
Impacts on cognitve function are glossed over. A little harder to quantify and attribute to blockers but could be just as consequential. There's likely permanent impacts in an animal model and authors believe it has implications for human adolescents
8/
sciencedirect.com
8/
sciencedirect.com
The Times commissions an evidence review on bone impacts. FWIW they find the same result I found when I reviewed the literature last year
9/
fullyinformed.nz
9/
fullyinformed.nz
Bone density somewhat recovers on females on testosterone but not in males on estradiol.
No studies on what happens if the kid comes off blockers and quits all medical interventions.
Hardly "reversible" as is often claimed
10/
No studies on what happens if the kid comes off blockers and quits all medical interventions.
Hardly "reversible" as is often claimed
10/
Notably the Times makes the point you can't extrpolate results from studies of blockers for early puberty (7-11) to gender-questioning kids (10-16).
This dodgy extrapolation underlies the claim that blockers are "safe and reversible", and brings us to the next milestone... 11/
This dodgy extrapolation underlies the claim that blockers are "safe and reversible", and brings us to the next milestone... 11/
.@minhealthnz finally removed the "safe and fully reversible" language from the website in September.
This was after >50 people emailing them over the years and pointing out that this language was unfounded and misleading. 12/
This was after >50 people emailing them over the years and pointing out that this language was unfounded and misleading. 12/
Its not entirely clear what prompted the change but could have been the recent articles in Newsroom
#Echobox=1660764318" target="_blank" rel="noopener" onclick="event.stopPropagation()">newsroom.co.nz
and the Listener (syndicated to the Herald)
nzherald.co.nz
13/
#Echobox=1660764318" target="_blank" rel="noopener" onclick="event.stopPropagation()">newsroom.co.nz
and the Listener (syndicated to the Herald)
nzherald.co.nz
13/
I have another OIA showing that @minhealthnz are planning an "evidence brief" on blockers and a senior offical thinks the guidelines promoted by clinicians in NZ needs updating.
14/
14/
The showstopper covered above is that based on Pharmac data the NZ prescribing rate of blockers for gender-questioning kids is 10x that of England+Wales per head of population.
16/
16/
Whatsmore, the UK are part way through a review and have decided to *scale back* blockers to medical trials.
The NHS considers "social transition" (adults pretending child is opp sex) a consequential intervention. Most kids will grow out of it (ie blockers not needed)
The NHS considers "social transition" (adults pretending child is opp sex) a consequential intervention. Most kids will grow out of it (ie blockers not needed)
Meanwhile a clinician here complains that a psychosocial, not drug, first approach is "expensive". Gotta do something so its an experimental drug restricted to medical trials in other countries apparently
(taxpayer picks up the tab via Pharmac)
rnz.co.nz
19/
(taxpayer picks up the tab via Pharmac)
rnz.co.nz
19/
Something's gotta give and there's more to come out. We'll see what the Minstry's evidence brief says but the Ministry, and international developments, look to be on a collision course with local "drug first" clinicians.
20/Fin
20/Fin
Loading suggestions...