Does Anyone Regret Voting Republican?

[Captain FIRE]

Yes - Robert Kennedy Jr has been and continues to be one of the most recognizable faces in the anti-vaccine movement. He continues to be the chairman of Children's Health Defense and continues to support the entirely debunked (and dangerous) theory that approved vaccines cause autism.

Do you have a data source with a long-term study of instances of autism in vaccinated vs unvaccinated children? I would love to have a bookmark in my phone so anytime an anti-vax proponent starts talking about autism, I can shut the conversation down immediately.

@Phenix Not sure if you are still interested in this information, but the original link between autism and vaccination was a Lancet article in 1998. It was then retracted by 10 of the 12 authors, and 12 years after publication Lancet retracted it as well. There were improperly disclosed financial incentives, small sample size, and bad design. The authors were even found guilty of deliberate fraud. This ONE terrible paper had profound implications creating a linkage that didn't exist (beyond that one tends to get diagnosed with autism about the time that vaccinations are done...so a correlation not causation).

So a better question might be what is the anti-vax's peer reviewed research studies that support a causal link, not you disproving it.

[former player]

The NHS in England has gone through the scientific and medical evidence for prescribing puberty suppressing hormones and decided that there isn't any:
https://www.england.nhs.uk/publication/clinical-policy-puberty-suppressing-hormones/

Reading through the links, that's not exactly what they said.  They said that solid evidence on the efficacy of prescribing puberty suppressors for gender dysmorphia was lacking due to the lack and poor quality of large scale studies done

The point here is whether you need evidence of benefit in order to prescribe medicines that have life-long physical consequences or whether you think it's OK to prescribe them in the absence of evidence of benefit.  If "first do no harm" still applies then there should be solid scientific evidence of benefit before prescribing.  And there isn't.

You can of course hold the opposite view: that it is fine to prescribe powerful drugs to children in the absence of good evidence of any benefit, but I can't see why anyone of sense and conscience would do so.

This is certainly a tricky part of the discussion.  Use of puberty blockers for pre-teens who want to transition has not been extensively studied as it's a relatively new thing.  In the past psychology treated transgenderism and homosexuality as diseases to be cured rather than part of who a person is.  We know that this certainly did harm.

I don't support out of hand looking at a kid, determining that the kid is trans, then prescribing powerful drugs and then surgery.  But that's not what happens today.  There is a long and multi-step process involving psychiatry, medical evaluation, and relying heavily upon the child's desires at each step.

The scant evidence we have so far shows that people who do choose to transition overwhelmingly report being happier having done so later in life.  While I reserve the right to change my mind as new evidence becomes available, right now I don't see any reason to deny children the ability to choose to do what they want with their bodies.

[...]

Our offspring has a LGBTQ+ friend-inclusive social circle. Given time those kids we have known well through middle and high school haved figured things out for themselves with a little parental guidance and in some cases medical supervision. Just give them space and privacy. one of the trans kids decided on their own volition that they were they gender they were born as after-all. Another is still trans. A lesbian decided she wasn't and another still is. And so on, and so forth. Folks just need to get out of the way of these families and let them sort it out in their own way.

I agree completely with this.  Provided only that letting the kids figure it out for themselves excludes giving them experimental drug treatments (and sometimes major surgery) for which there is no good, well-researched medical evidence showing long-term outcomes, which may have life-long health implications and which at least some of them will come to regret.

[PeteD01]

https://bigthink.com/health/transgender-detransition/

That is a decent discussion of the subject.

[nereo]

It’s frankly baffling to me that the party of “limited government” from my youth now spends a disproportionate amount of time trying to contradict the recommendations of medical boards and prevent parents from making decisions they feel are in their families best interest, particularly for such a small constituency. The loudest voices in opposition all too often are not directly involved, yet are desperate for the government to limit what others can do.

[GuitarStv]

Why should the GOP care what a small percentage of families are quietly sorting out? But the conservatives seem to be highly involved in something that is nobody's business.

I've assumed that (much like the objections to gay people) most of the resistance is religiously driven.

There was always a little crossover, but in my lifetime the GOP has completely transitioned from economic conservatism (small government, limited budgets and spending) to social conservatism (enforcing old cultural and religious norms with a jingoistic streak).  They no longer appear interested in the former at all.

[Omy]

An extended family member is transitioning in his late teens as we speak. His parents had him in counseling for years before he began hormone injections 18 months ago.

He has absolutely transformed from miserable to joyous from the medical intervention. He went from barely getting passing grades in middle school to applying for and getting a full ride to the college of his choice. He's brilliant and outgoing now instead of withdrawn and depressed.

It's been a huge adjustment for his parents, but they are supportive and loving and glad that it's turned out so well for him. They have their concerns but are so much more optimistic about his future than they were when he was a miserable kid.

For those who are unable to let people make their health decisions independently, ask yourself how this has any affect on you. Is my family member's health and happiness taking anything away from you?

[former player]

An extended family member is transitioning in his late teens as we speak. His parents had him in counseling for years before he began hormone injections 18 months ago.

He has absolutely transformed from miserable to joyous from the medical intervention. He went from barely getting passing grades in middle school to applying for and getting a full ride to the college of his choice. He's brilliant and outgoing now instead of withdrawn and depressed.

It's been a huge adjustment for his parents, but they are supportive and loving and glad that it's turned out so well for him. They have their concerns but are so much more optimistic about his future than they were when he was a miserable kid.

For those who are unable to let people make their health decisions independently, ask yourself how this has any affect on you. Is my family member's health and happiness taking anything away from you?

I hope your relative continues to do well.

I have no objection to legal adults (I assume "late teens" means legal adult) taking cross-sex hormones or having plastic surgery, provided they are fully informed and able to consent.  I would note that neither testoterone nor estrogen have been approved for gender transition purposes by the FDA or the drug companies and that all prescribing of those drugs for cross-sex purposes is off label, and that these drugs have irreversible long-term effects, including as to their safety that have not been scientifically studied to the level needed for them to be FDA approved.  But if a competent adult knowing that still wants to go ahead that's up to them.

I have big objections to the same untested-for-the-purpose off-label unapproved drugs, plus puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

[GuitarStv]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

[former player]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

[jrhampt]

I must admit that I don't really understand the trans thing.  As a feminist, my thesis has always been that gender should ideally be pretty not important and we should all be free to dress and act however we want without negative social repercussions and not feel pressured to conform to gender stereotypes.  I have a suspicion that if this ideal world existed (and as part of this ideal world homosexuality would be accepted as a completely valid state of being on par with heterosexuality), fewer people would feel the need to transition.

That said, I am also a firm believer in bodily autonomy, and I don't need to understand the trans thing to respect that it is not my decision to make for anyone else.  It's really none of my business whatever a person and their doctor decide to do with their bodies, doesn't impact me at all (unless we're talking about communicable diseases and things like the measles vaccine).

[Sandi_k]

I hope your relative continues to do well.

I have no objection to legal adults (I assume "late teens" means legal adult) taking cross-sex hormones or having plastic surgery, provided they are fully informed and able to consent.

And again, we ask: Is my family member's health and happiness taking anything away from you?

I have a family member who was suicidal as a teen. Three attempts, one very close.

His mother finally agreed to top surgery at age 17, because she figured alive and without boobs was better than dead with boobs.

He is now in college, and doing well.

I think mom made the right choice, and cannot understand why this is anyone's business but the people involved, and their doctor.

[GuitarStv]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

This argument makes no sense.

Puberty blockers have been tested and approved for on-label use in younger children since the 1980s for treating precocious puberty.  They absolutely make permanent changes to an otherwise healthy body, and many of the same adverse consequences you're complaining about are present in on-label use as well.  All the drugs mentioned that are being used off label are also being used for an approved purpose (helping trans teens to prevent growing sex characteristics that they don't want).

How is this not the same thing?

[former player]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

This argument makes no sense.

Puberty blockers have been tested and approved for on-label use in younger children since the 1980s for treating precocious puberty.  They absolutely make permanent changes to an otherwise healthy body, and many of the same adverse consequences you're complaining about are present in on-label use as well.  All the drugs mentioned that are being used off label are also being used for an approved purpose (helping trans teens to prevent growing sex characteristics that they don't want).

How is this not the same thing?

Can you point me to the FDA approval for puberty blockers or cross-sex hormones in underage children for the purposes of changing their sexual characteristics?  Thanks

[bacchi]

I must admit that I don't really understand the trans thing.  As a feminist, my thesis has always been that gender should ideally be pretty not important and we should all be free to dress and act however we want without negative social repercussions and not feel pressured to conform to gender stereotypes.  I have a suspicion that if this ideal world existed (and as part of this ideal world homosexuality would be accepted as a completely valid state of being on par with heterosexuality), fewer people would feel the need to transition.

Agreed.

Somewhat related, a large majority in most gender clinics are now biological girls questioning their gender. There's an answer somewhere as to why this is and it's probably connected to how girls and women are still somewhat 2nd class citizens, even in industrialized countries. Or maybe a boy transitioning is less accepted.

[Omy]

I hope your relative continues to do well.

I have no objection to legal adults (I assume "late teens" means legal adult) taking cross-sex hormones or having plastic surgery, provided they are fully informed and able to consent.

And again, we ask: Is my family member's health and happiness taking anything away from you?

I have a family member who was suicidal as a teen. Three attempts, one very close.

His mother finally agreed to top surgery at age 17, because she figured alive and without boobs was better than dead with boobs.

He is now in college, and doing well.

I think mom made the right choice, and cannot understand why this is anyone's business but the people involved, and their doctor.

Exactly this. The narrative that parents are irresponsible for allowing their children to do this is complete BS.

[GuitarStv]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

This argument makes no sense.

Puberty blockers have been tested and approved for on-label use in younger children since the 1980s for treating precocious puberty.  They absolutely make permanent changes to an otherwise healthy body, and many of the same adverse consequences you're complaining about are present in on-label use as well.  All the drugs mentioned that are being used off label are also being used for an approved purpose (helping trans teens to prevent growing sex characteristics that they don't want).

How is this not the same thing?

Can you point me to the FDA approval for puberty blockers or cross-sex hormones in underage children for the purposes of changing their sexual characteristics?  Thanks

Sure.  Lupron (as the first example) is a puberty blocker that was FDA approved for precocious puberty in children in '95 - https://www.accessdata.fda.gov/drugsatfda_docs/nda/pre96/019943_LupronTOC.cfm

You can also search for and find FDA approvals for Zoladex, Trelstar, Viadur, and Eligard for use in children.  All are GnRH agonists and approved for puberty blocking in cases of precocious puberty.  None are FDA approved for the common off-label use of puberty blocking in the case of gender dysmorphia.

[former player]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

This argument makes no sense.

Puberty blockers have been tested and approved for on-label use in younger children since the 1980s for treating precocious puberty.  They absolutely make permanent changes to an otherwise healthy body, and many of the same adverse consequences you're complaining about are present in on-label use as well.  All the drugs mentioned that are being used off label are also being used for an approved purpose (helping trans teens to prevent growing sex characteristics that they don't want).

How is this not the same thing?

Can you point me to the FDA approval for puberty blockers or cross-sex hormones in underage children for the purposes of changing their sexual characteristics?  Thanks

Sure.  Lupron (as the first example) is a puberty blocker that was FDA approved for precocious puberty in children in '95 - https://www.accessdata.fda.gov/drugsatfda_docs/nda/pre96/019943_LupronTOC.cfm

You can also search for and find FDA approvals for Zoladex, Trelstar, Viadur, and Eligard for use in children.  All are GnRH agonists and approved for puberty blocking in cases of precocious puberty.  None are FDA approved for the common off-label use of puberty blocking in the case of gender dysmorphia.

That's not an answer to what I said.  Delaying precocious puberty for physical health reasons is one thing, and approved by the FDA, denying puberty altogether for mental health reasons is completely different in purpose and effect and is not approved by the FDA.

And you don't appear to have provided an answer as to cross-sex hormones in children?

[PeteD01]

Prescribing off-label is common practice to the tune of up to one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.


Agency for Healthcare Research and Quality:

Off-Label Drugs: What You Need to Know

Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.

https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.html#:~:text=Off%2Dlabel%20prescribing%20is%20when,are%20for%20off%2Dlabel%20use.

[GuitarStv]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

This argument makes no sense.

Puberty blockers have been tested and approved for on-label use in younger children since the 1980s for treating precocious puberty.  They absolutely make permanent changes to an otherwise healthy body, and many of the same adverse consequences you're complaining about are present in on-label use as well.  All the drugs mentioned that are being used off label are also being used for an approved purpose (helping trans teens to prevent growing sex characteristics that they don't want).

How is this not the same thing?

Can you point me to the FDA approval for puberty blockers or cross-sex hormones in underage children for the purposes of changing their sexual characteristics?  Thanks

Sure.  Lupron (as the first example) is a puberty blocker that was FDA approved for precocious puberty in children in '95 - https://www.accessdata.fda.gov/drugsatfda_docs/nda/pre96/019943_LupronTOC.cfm

You can also search for and find FDA approvals for Zoladex, Trelstar, Viadur, and Eligard for use in children.  All are GnRH agonists and approved for puberty blocking in cases of precocious puberty.  None are FDA approved for the common off-label use of puberty blocking in the case of gender dysmorphia.

That's not an answer to what I said.  Delaying precocious puberty for physical health reasons is one thing, and approved by the FDA, denying puberty altogether for mental health reasons is completely different in purpose and effect and is not approved by the FDA.

Then I don't understand what you're getting at.  I've already pointed out that off-label use of drugs is very common practice in pediatrics.  Puberty blockers have been approved and used on children for a long time to change their sexual characteristics (that's what happens in treatment of precocious puberty - you delay puberty that a doctor has decided occurred too early).  Precocious puberty is treated to a large degree to prevent emotional and behavioral issues (psychological issues).

It really sounds like the issue you have is not the safety of the use of the drugs or use for psychological treatment, but simply the purpose of using the drugs when helping children who want to transition.

[former player]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

[GuitarStv]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Do you rail as hard against kids with asthma puffers?  Albuterol is a super common off-label drug given to kids 2-12.

[former player]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Do you rail as hard against kids with asthma puffers?  Albuterol is a super common off-label drug given to kids 2-12.

Asthma puffers 1) ameliorate an objectively known adverse medical condition, 2) do not otherwise change a child's physical development and 3) have no known long-term adverse physical effects.  Again, really not comparing like with like.

As I've said before, I don't think kids should be given unapproved and scientifically unjustified for the purposes drugs that permanently change their physical, and potentially mental, development in response to social and mental issues that in many cases resolve themselves as the children grow up.

[PeteD01]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Nonsense, ADRs happen for a multitude of reasons and inappropriate use as labeled and off-label are certainly among those.

Off-label does not signify at all that a drug is used inappropriately and also does not imply that the risk is higher than as labeled use.

The reason that off-label use is so common is that manufacturers often do not pursue approval due to cost and concern of return of that investment and also new uses for off patent older medications where there is no incentive for perfoming expensive studies.

Creating obstacles for off-label use would disproportionately harm patients with rare diseases and vulnerable groups such as pregnant and pediatric patients.

Asking for obtaining FDA approval for puberty blockers and hormones in the minuscule gender dysphoric/transgender population is de facto an attempt to make the treatments unavailable and also singles out that population for discrimination.

[GuitarStv]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Do you rail as hard against kids with asthma puffers?  Albuterol is a super common off-label drug given to kids 2-12.

Asthma puffers 1) ameliorate an objectively known adverse medical condition, 2) do not otherwise change a child's physical development and 3) have no known long-term adverse physical effects.  Again, really not comparing like with like.

So if I understand your complaint correctly then, it very narrowly applies to products that have known long term physical effects which are approved for kids treatment of some psychological problems (precocious puberty) but not approved and used off label for treatment of other psychological problems (gender dysmorphia)?

This is a suspiciously oddly specific concern.

[former player]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Nonsense, ADRs happen for a multitude of reasons and inappropriate use as labeled and off-label are certainly among those.

Off-label does not signify at all that a drug is used inappropriately and also does not imply that the risk is higher than as labeled use.

The reason that off-label use is so common is that manufacturers often do not pursue approval due to cost and concern of return of that investment and also new uses for off patent older medications where there is no incentive for perfoming expensive studies.

Creating obstacles for off-label use would disproportionately harm patients with rare diseases and vulnerable groups such as pregnant and pediatric patients.

Asking for obtaining FDA approval for puberty blockers and hormones in the minuscule gender dysphoric/transgender population is de facto an attempt to make the treatments unavailable and also singles out that population for discrimination.

Apparently there are 300,000 transgender youth (13 to 17) and 1.3 million transgender adults just in the USA alone.  If the drug companies wanted to pursue FDA approval it would surely be financially justified for such a large group of people.  My guess is that they haven't done it, and won't try to do it, because they know that those uses couldn't possibly pass the requirements for medical need and limited harm that approval requires.

[former player]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Do you rail as hard against kids with asthma puffers?  Albuterol is a super common off-label drug given to kids 2-12.

Asthma puffers 1) ameliorate an objectively known adverse medical condition, 2) do not otherwise change a child's physical development and 3) have no known long-term adverse physical effects.  Again, really not comparing like with like.

So if I understand your complaint correctly then, it very narrowly applies to products that have known long term physical effects which are approved for kids treatment of some psychological problems (precocious puberty) but not approved and used off label for treatment of other psychological problems (gender dysmorphia)?

This is a suspiciously oddly specific concern.

Precocious puberty is a physical problem not (or not only) a psychological one.

[GuitarStv]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Do you rail as hard against kids with asthma puffers?  Albuterol is a super common off-label drug given to kids 2-12.

Asthma puffers 1) ameliorate an objectively known adverse medical condition, 2) do not otherwise change a child's physical development and 3) have no known long-term adverse physical effects.  Again, really not comparing like with like.

So if I understand your complaint correctly then, it very narrowly applies to products that have known long term physical effects which are approved for kids treatment of some psychological problems (precocious puberty) but not approved and used off label for treatment of other psychological problems (gender dysmorphia)?

This is a suspiciously oddly specific concern.

Precocious puberty is a physical problem not (or not only) a psychological one.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415463/

There exist brain differences in people who have gender dysphoria - which would mean that it's (at least partly) a physical problem.  So I'm not seeing the line of differentiation that you're drawing here.

[Villanelle]

An extended family member is transitioning in his late teens as we speak. His parents had him in counseling for years before he began hormone injections 18 months ago.

He has absolutely transformed from miserable to joyous from the medical intervention. He went from barely getting passing grades in middle school to applying for and getting a full ride to the college of his choice. He's brilliant and outgoing now instead of withdrawn and depressed.

It's been a huge adjustment for his parents, but they are supportive and loving and glad that it's turned out so well for him. They have their concerns but are so much more optimistic about his future than they were when he was a miserable kid.

For those who are unable to let people make their health decisions independently, ask yourself how this has any affect on you. Is my family member's health and happiness taking anything away from you?

I hope your relative continues to do well.

I have no objection to legal adults (I assume "late teens" means legal adult) taking cross-sex hormones or having plastic surgery, provided they are fully informed and able to consent.  I would note that neither testoterone nor estrogen have been approved for gender transition purposes by the FDA or the drug companies and that all prescribing of those drugs for cross-sex purposes is off label, and that these drugs have irreversible long-term effects, including as to their safety that have not been scientifically studied to the level needed for them to be FDA approved.  But if a competent adult knowing that still wants to go ahead that's up to them.

I have big objections to the same untested-for-the-purpose off-label unapproved drugs, plus puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

I assume feel the same about 16 year olds getting nose jobs.  Or pierced ears. 

[Kris]

An extended family member is transitioning in his late teens as we speak. His parents had him in counseling for years before he began hormone injections 18 months ago.

He has absolutely transformed from miserable to joyous from the medical intervention. He went from barely getting passing grades in middle school to applying for and getting a full ride to the college of his choice. He's brilliant and outgoing now instead of withdrawn and depressed.

It's been a huge adjustment for his parents, but they are supportive and loving and glad that it's turned out so well for him. They have their concerns but are so much more optimistic about his future than they were when he was a miserable kid.

For those who are unable to let people make their health decisions independently, ask yourself how this has any affect on you. Is my family member's health and happiness taking anything away from you?

I hope your relative continues to do well.

I have no objection to legal adults (I assume "late teens" means legal adult) taking cross-sex hormones or having plastic surgery, provided they are fully informed and able to consent.  I would note that neither testoterone nor estrogen have been approved for gender transition purposes by the FDA or the drug companies and that all prescribing of those drugs for cross-sex purposes is off label, and that these drugs have irreversible long-term effects, including as to their safety that have not been scientifically studied to the level needed for them to be FDA approved.  But if a competent adult knowing that still wants to go ahead that's up to them.

I have big objections to the same untested-for-the-purpose off-label unapproved drugs, plus puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

I assume feel the same about 16 year olds getting nose jobs.  Or pierced ears.

Or treatment for cystic acne.

[PeteD01]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Nonsense, ADRs happen for a multitude of reasons and inappropriate use as labeled and off-label are certainly among those.

Off-label does not signify at all that a drug is used inappropriately and also does not imply that the risk is higher than as labeled use.

The reason that off-label use is so common is that manufacturers often do not pursue approval due to cost and concern of return of that investment and also new uses for off patent older medications where there is no incentive for perfoming expensive studies.

Creating obstacles for off-label use would disproportionately harm patients with rare diseases and vulnerable groups such as pregnant and pediatric patients.

Asking for obtaining FDA approval for puberty blockers and hormones in the minuscule gender dysphoric/transgender population is de facto an attempt to make the treatments unavailable and also singles out that population for discrimination.

Apparently there are 300,000 transgender youth (13 to 17) and 1.3 million transgender adults just in the USA alone.  If the drug companies wanted to pursue FDA approval it would surely be financially justified for such a large group of people.  My guess is that they haven't done it, and won't try to do it, because they know that those uses couldn't possibly pass the requirements for medical need and limited harm that approval requires.

You do not seem to be familiar with the way the pharmaceutical industry works.
The main motivator for the to pursue expensive research is to create a new market or replace competitor drugs.

The market for these drugs already exists, the drugs are working and have entered the stage were ADRs are reported to the FDA and monitored there.

It is not that the job of the FDA is done after approval, it just does not involve large scale studies unless safety signals indicate a need.
Over time, this FDA activity typically leads to an ever expanding package insert with additional risks, warnings and withdrawal from the market in extreme cases.

One could justifiably say that most of the safety data on drugs is generated after release to the market and puberty blockers and hormones are subject to monitoring just like any other drug.

The research required for approval is to convincingly demonstrate efficacy and the absence of major short and intermediate term ADRs.

I think it is not difficult to understand that a drug that has been around for monitoring for a long time and is used off-label is more likely to be safer, or at least more predictable, than a recently approved drug with hardly any post-approval safety data yet available.

FDA-TRACK: Center for Drug Evaluation and Research - Post-Approval Safety Monitoring - Patient Safety Tools Dashboard

https://www.fda.gov/about-fda/fda-track-agency-wide-program-performance/fda-track-center-drug-evaluation-and-research-post-approval-safety-monitoring-patient-safety-tools#:~:text=FAERS%20is%20an%20FDA%20database,safety%20of%20FDA%2Dapproved%20products.

[former player]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Do you rail as hard against kids with asthma puffers?  Albuterol is a super common off-label drug given to kids 2-12.

Asthma puffers 1) ameliorate an objectively known adverse medical condition, 2) do not otherwise change a child's physical development and 3) have no known long-term adverse physical effects.  Again, really not comparing like with like.

So if I understand your complaint correctly then, it very narrowly applies to products that have known long term physical effects which are approved for kids treatment of some psychological problems (precocious puberty) but not approved and used off label for treatment of other psychological problems (gender dysmorphia)?

This is a suspiciously oddly specific concern.

Precocious puberty is a physical problem not (or not only) a psychological one.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415463/

There exist brain differences in people who have gender dysphoria - which would mean that it's (at least partly) a physical problem.  So I'm not seeing the line of differentiation that you're drawing here.

Dear dog, the opening paragraphs tell me that paper is a mess.

"When research has been conducted in people with Androgen Insensitivity Syndrome, a condition where the testosterone receptor is mutated and faulty, and thus cannot function, gender dysphoria is observed as the body is genetically male but anatomically female. "
Androgen Insensitivity Syndrome is not "gender dysphoria", it is a difference in sexual development (DSD) in which people are identified as and grow up as female and are often only identified as having a DSD in relation to fertility issues. It has nothing to do with "gender dysphoria".  For a paper to make such a fundamental error discredits the whole thing.  There is also nothing in the paper that controls either for natural variations in masculinity and femininity in males and females or for homosexuality, particularly in feminine gay men and masculine lesbians: there is unfortunately, in a homophobic society, a current trend in which it can be socially easier for children to identify as trans rather than gay or lesbian, and there is also a sad incidence of homophobic parents (and possibly also homophobic doctors) preferring to trans kids into being heterosexual rather than remain as gay in their birth sex.

[former player]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Nonsense, ADRs happen for a multitude of reasons and inappropriate use as labeled and off-label are certainly among those.

Off-label does not signify at all that a drug is used inappropriately and also does not imply that the risk is higher than as labeled use.

The reason that off-label use is so common is that manufacturers often do not pursue approval due to cost and concern of return of that investment and also new uses for off patent older medications where there is no incentive for perfoming expensive studies.

Creating obstacles for off-label use would disproportionately harm patients with rare diseases and vulnerable groups such as pregnant and pediatric patients.

Asking for obtaining FDA approval for puberty blockers and hormones in the minuscule gender dysphoric/transgender population is de facto an attempt to make the treatments unavailable and also singles out that population for discrimination.

Apparently there are 300,000 transgender youth (13 to 17) and 1.3 million transgender adults just in the USA alone.  If the drug companies wanted to pursue FDA approval it would surely be financially justified for such a large group of people.  My guess is that they haven't done it, and won't try to do it, because they know that those uses couldn't possibly pass the requirements for medical need and limited harm that approval requires.

You do not seem to be familiar with the way the pharmaceutical industry works.
The main motivator for the to pursue expensive research is to create a new market or replace competitor drugs.

The market for these drugs already exists, the drugs are working and have entered the stage were ADRs are reported to the FDA and monitored there.

It is not that the job of the FDA is done after approval, it just does not involve large scale studies unless safety signals indicate a need.
Over time, this FDA activity typically leads to an ever expanding package insert with additional risks, warnings and withdrawal from the market in extreme cases.

One could justifiably say that most of the safety data on drugs is generated after release to the market and puberty blockers and hormones are subject to monitoring just like any other drug.

The research required for approval is to convincingly demonstrate efficacy and the absence of major short and intermediate term ADRs.

I think it is not difficult to understand that a drug that has been around for monitoring for a long time and is used off-label is more likely to be safer, or at least more predictable, than a recently approved drug with hardly any post-approval safety data yet available.

FDA-TRACK: Center for Drug Evaluation and Research - Post-Approval Safety Monitoring - Patient Safety Tools Dashboard

https://www.fda.gov/about-fda/fda-track-agency-wide-program-performance/fda-track-center-drug-evaluation-and-research-post-approval-safety-monitoring-patient-safety-tools#:~:text=FAERS%20is%20an%20FDA%20database,safety%20of%20FDA%2Dapproved%20products.

The drugs aren't "working" as should be clear from the reports I've referenced, in particular the NHS review, but also reviews from many other European countries, including the Netherlands which has repudiated the original "Dutch protocol" which started this whole horror show off.

[former player]

An extended family member is transitioning in his late teens as we speak. His parents had him in counseling for years before he began hormone injections 18 months ago.

He has absolutely transformed from miserable to joyous from the medical intervention. He went from barely getting passing grades in middle school to applying for and getting a full ride to the college of his choice. He's brilliant and outgoing now instead of withdrawn and depressed.

It's been a huge adjustment for his parents, but they are supportive and loving and glad that it's turned out so well for him. They have their concerns but are so much more optimistic about his future than they were when he was a miserable kid.

For those who are unable to let people make their health decisions independently, ask yourself how this has any affect on you. Is my family member's health and happiness taking anything away from you?

I hope your relative continues to do well.

I have no objection to legal adults (I assume "late teens" means legal adult) taking cross-sex hormones or having plastic surgery, provided they are fully informed and able to consent.  I would note that neither testoterone nor estrogen have been approved for gender transition purposes by the FDA or the drug companies and that all prescribing of those drugs for cross-sex purposes is off label, and that these drugs have irreversible long-term effects, including as to their safety that have not been scientifically studied to the level needed for them to be FDA approved.  But if a competent adult knowing that still wants to go ahead that's up to them.

I have big objections to the same untested-for-the-purpose off-label unapproved drugs, plus puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

I assume feel the same about 16 year olds getting nose jobs.  Or pierced ears.

Or treatment for cystic acne.

The correct comparison for puberty blockers (which only work if puberty is not complete) would be a nose job for an 11 or 12 year old, and yes I'd object to that.  Pierced ears are neither here nor there compared to the effects of puberty blockers that can leave kids infertile and without adult sexual function (ie never able to achieve orgasm or have penetrative sexual intercourse).

Cystic acne is a phsyical health issue which can be resolved through medicine and physical treatments without permanent adverse effects (although there are known side effects to the medicine which need to be taken into account when prescribing).

[Villanelle]

An extended family member is transitioning in his late teens as we speak. His parents had him in counseling for years before he began hormone injections 18 months ago.

He has absolutely transformed from miserable to joyous from the medical intervention. He went from barely getting passing grades in middle school to applying for and getting a full ride to the college of his choice. He's brilliant and outgoing now instead of withdrawn and depressed.

It's been a huge adjustment for his parents, but they are supportive and loving and glad that it's turned out so well for him. They have their concerns but are so much more optimistic about his future than they were when he was a miserable kid.

For those who are unable to let people make their health decisions independently, ask yourself how this has any affect on you. Is my family member's health and happiness taking anything away from you?

I hope your relative continues to do well.

I have no objection to legal adults (I assume "late teens" means legal adult) taking cross-sex hormones or having plastic surgery, provided they are fully informed and able to consent.  I would note that neither testoterone nor estrogen have been approved for gender transition purposes by the FDA or the drug companies and that all prescribing of those drugs for cross-sex purposes is off label, and that these drugs have irreversible long-term effects, including as to their safety that have not been scientifically studied to the level needed for them to be FDA approved.  But if a competent adult knowing that still wants to go ahead that's up to them.

I have big objections to the same untested-for-the-purpose off-label unapproved drugs, plus puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

I assume feel the same about 16 year olds getting nose jobs.  Or pierced ears.

Or treatment for cystic acne.

The correct comparison for puberty blockers (which only work if puberty is not complete) would be a nose job for an 11 or 12 year old, and yes I'd object to that.  Pierced ears are neither here nor there compared to the effects of puberty blockers that can leave kids infertile and without adult sexual function (ie never able to achieve orgasm or have penetrative sexual intercourse).

Cystic acne is a phsyical health issue which can be resolved through medicine and physical treatments without permanent adverse effects (although there are known side effects to the medicine which need to be taken into account when prescribing).

So you are okay with piercings?  People allow those for kids much younger than 12 (sometimes >1yo).  And they can lead to keloids, which can be difficult or impossible to remove.  But it's cool as long as the kid can still have an orgasm, I guess?



P

[PeteD01]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Nonsense, ADRs happen for a multitude of reasons and inappropriate use as labeled and off-label are certainly among those.

Off-label does not signify at all that a drug is used inappropriately and also does not imply that the risk is higher than as labeled use.

The reason that off-label use is so common is that manufacturers often do not pursue approval due to cost and concern of return of that investment and also new uses for off patent older medications where there is no incentive for perfoming expensive studies.

Creating obstacles for off-label use would disproportionately harm patients with rare diseases and vulnerable groups such as pregnant and pediatric patients.

Asking for obtaining FDA approval for puberty blockers and hormones in the minuscule gender dysphoric/transgender population is de facto an attempt to make the treatments unavailable and also singles out that population for discrimination.

Apparently there are 300,000 transgender youth (13 to 17) and 1.3 million transgender adults just in the USA alone.  If the drug companies wanted to pursue FDA approval it would surely be financially justified for such a large group of people.  My guess is that they haven't done it, and won't try to do it, because they know that those uses couldn't possibly pass the requirements for medical need and limited harm that approval requires.

You do not seem to be familiar with the way the pharmaceutical industry works.
The main motivator for the to pursue expensive research is to create a new market or replace competitor drugs.

The market for these drugs already exists, the drugs are working and have entered the stage were ADRs are reported to the FDA and monitored there.

It is not that the job of the FDA is done after approval, it just does not involve large scale studies unless safety signals indicate a need.
Over time, this FDA activity typically leads to an ever expanding package insert with additional risks, warnings and withdrawal from the market in extreme cases.

One could justifiably say that most of the safety data on drugs is generated after release to the market and puberty blockers and hormones are subject to monitoring just like any other drug.

The research required for approval is to convincingly demonstrate efficacy and the absence of major short and intermediate term ADRs.

I think it is not difficult to understand that a drug that has been around for monitoring for a long time and is used off-label is more likely to be safer, or at least more predictable, than a recently approved drug with hardly any post-approval safety data yet available.

FDA-TRACK: Center for Drug Evaluation and Research - Post-Approval Safety Monitoring - Patient Safety Tools Dashboard

https://www.fda.gov/about-fda/fda-track-agency-wide-program-performance/fda-track-center-drug-evaluation-and-research-post-approval-safety-monitoring-patient-safety-tools#:~:text=FAERS%20is%20an%20FDA%20database,safety%20of%20FDA%2Dapproved%20products.

The drugs aren't "working" as should be clear from the reports I've referenced, in particular the NHS review, but also reviews from many other European countries, including the Netherlands which has repudiated the original "Dutch protocol" which started this whole horror show off.

Last time I looked, puberty blockers are still reliably blocking puberty so they are "working" in a technical sense.

The "Dutch protocol" is something that is definitely worth discussing but the elephant in the room is actually this:

A detransitioning rate of 1% or less as reported in the past is worrisome but not for the reason one might presume.
When compared with other medical/surgical interventions it is an extremely low "regret rate" which seems to be moving to a more comparable level.

When confronted with such an extremely low "regret rate", one has to ask if the criteria used to make the indication for transitioning are possibly too narrow - meaning that a lot of patients are going untreated because practitioners are excessively trying to stay on the safe side.

The revision of the "Dutch protocol" has lowered the threshold for treatment but there is a legitimate discussion to be had if it was done in the right way - not a simple undertaking at all.

[former player]

An extended family member is transitioning in his late teens as we speak. His parents had him in counseling for years before he began hormone injections 18 months ago.

He has absolutely transformed from miserable to joyous from the medical intervention. He went from barely getting passing grades in middle school to applying for and getting a full ride to the college of his choice. He's brilliant and outgoing now instead of withdrawn and depressed.

It's been a huge adjustment for his parents, but they are supportive and loving and glad that it's turned out so well for him. They have their concerns but are so much more optimistic about his future than they were when he was a miserable kid.

For those who are unable to let people make their health decisions independently, ask yourself how this has any affect on you. Is my family member's health and happiness taking anything away from you?

I hope your relative continues to do well.

I have no objection to legal adults (I assume "late teens" means legal adult) taking cross-sex hormones or having plastic surgery, provided they are fully informed and able to consent.  I would note that neither testoterone nor estrogen have been approved for gender transition purposes by the FDA or the drug companies and that all prescribing of those drugs for cross-sex purposes is off label, and that these drugs have irreversible long-term effects, including as to their safety that have not been scientifically studied to the level needed for them to be FDA approved.  But if a competent adult knowing that still wants to go ahead that's up to them.

I have big objections to the same untested-for-the-purpose off-label unapproved drugs, plus puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

I assume feel the same about 16 year olds getting nose jobs.  Or pierced ears.

Or treatment for cystic acne.

The correct comparison for puberty blockers (which only work if puberty is not complete) would be a nose job for an 11 or 12 year old, and yes I'd object to that.  Pierced ears are neither here nor there compared to the effects of puberty blockers that can leave kids infertile and without adult sexual function (ie never able to achieve orgasm or have penetrative sexual intercourse).

Cystic acne is a phsyical health issue which can be resolved through medicine and physical treatments without permanent adverse effects (although there are known side effects to the medicine which need to be taken into account when prescribing).

So you are okay with piercings?  People allow those for kids much younger than 12 (sometimes >1yo).  And they can lead to keloids, which can be difficult or impossible to remove.  But it's cool as long as the kid can still have an orgasm, I guess?



P

Ear pierching is not usually a medical procedure and with a bit of care doesn't usually cause any ill effects - and is certainly not intended to.  In some parts of my country (the UK there is still a minimum age of 16 for ear piercing, and nipple and genital piercings are only for the over 16s.

Permanently removing a child's adult sexual function and fertility is more serious than an ear piercing, even if the piercing goes wrong.  It essentially removes that child from dating and creating a family life based on a sexual relationship, something most adults want at some point and something that no child can realistically say that they will never want.

[Just Joe]

The NHS in England has gone through the scientific and medical evidence for prescribing puberty suppressing hormones and decided that there isn't any:
https://www.england.nhs.uk/publication/clinical-policy-puberty-suppressing-hormones/

Reading through the links, that's not exactly what they said.  They said that solid evidence on the efficacy of prescribing puberty suppressors for gender dysmorphia was lacking due to the lack and poor quality of large scale studies done

The point here is whether you need evidence of benefit in order to prescribe medicines that have life-long physical consequences or whether you think it's OK to prescribe them in the absence of evidence of benefit.  If "first do no harm" still applies then there should be solid scientific evidence of benefit before prescribing.  And there isn't.

You can of course hold the opposite view: that it is fine to prescribe powerful drugs to children in the absence of good evidence of any benefit, but I can't see why anyone of sense and conscience would do so.

This is certainly a tricky part of the discussion.  Use of puberty blockers for pre-teens who want to transition has not been extensively studied as it's a relatively new thing.  In the past psychology treated transgenderism and homosexuality as diseases to be cured rather than part of who a person is.  We know that this certainly did harm.

I don't support out of hand looking at a kid, determining that the kid is trans, then prescribing powerful drugs and then surgery.  But that's not what happens today.  There is a long and multi-step process involving psychiatry, medical evaluation, and relying heavily upon the child's desires at each step.

The scant evidence we have so far shows that people who do choose to transition overwhelmingly report being happier having done so later in life.  While I reserve the right to change my mind as new evidence becomes available, right now I don't see any reason to deny children the ability to choose to do what they want with their bodies.

[...]

Our offspring has a LGBTQ+ friend-inclusive social circle. Given time those kids we have known well through middle and high school haved figured things out for themselves with a little parental guidance and in some cases medical supervision. Just give them space and privacy. one of the trans kids decided on their own volition that they were they gender they were born as after-all. Another is still trans. A lesbian decided she wasn't and another still is. And so on, and so forth. Folks just need to get out of the way of these families and let them sort it out in their own way.

I agree completely with this.  Provided only that letting the kids figure it out for themselves excludes giving them experimental drug treatments (and sometimes major surgery) for which there is no good, well-researched medical evidence showing long-term outcomes, which may have life-long health implications and which at least some of them will come to regret.

It maybe that our friend circle isn't rich enough to actually pursue the medical side beyond counseling.

[former player]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Nonsense, ADRs happen for a multitude of reasons and inappropriate use as labeled and off-label are certainly among those.

Off-label does not signify at all that a drug is used inappropriately and also does not imply that the risk is higher than as labeled use.

The reason that off-label use is so common is that manufacturers often do not pursue approval due to cost and concern of return of that investment and also new uses for off patent older medications where there is no incentive for perfoming expensive studies.

Creating obstacles for off-label use would disproportionately harm patients with rare diseases and vulnerable groups such as pregnant and pediatric patients.

Asking for obtaining FDA approval for puberty blockers and hormones in the minuscule gender dysphoric/transgender population is de facto an attempt to make the treatments unavailable and also singles out that population for discrimination.

Apparently there are 300,000 transgender youth (13 to 17) and 1.3 million transgender adults just in the USA alone.  If the drug companies wanted to pursue FDA approval it would surely be financially justified for such a large group of people.  My guess is that they haven't done it, and won't try to do it, because they know that those uses couldn't possibly pass the requirements for medical need and limited harm that approval requires.

You do not seem to be familiar with the way the pharmaceutical industry works.
The main motivator for the to pursue expensive research is to create a new market or replace competitor drugs.

The market for these drugs already exists, the drugs are working and have entered the stage were ADRs are reported to the FDA and monitored there.

It is not that the job of the FDA is done after approval, it just does not involve large scale studies unless safety signals indicate a need.
Over time, this FDA activity typically leads to an ever expanding package insert with additional risks, warnings and withdrawal from the market in extreme cases.

One could justifiably say that most of the safety data on drugs is generated after release to the market and puberty blockers and hormones are subject to monitoring just like any other drug.

The research required for approval is to convincingly demonstrate efficacy and the absence of major short and intermediate term ADRs.

I think it is not difficult to understand that a drug that has been around for monitoring for a long time and is used off-label is more likely to be safer, or at least more predictable, than a recently approved drug with hardly any post-approval safety data yet available.

FDA-TRACK: Center for Drug Evaluation and Research - Post-Approval Safety Monitoring - Patient Safety Tools Dashboard

https://www.fda.gov/about-fda/fda-track-agency-wide-program-performance/fda-track-center-drug-evaluation-and-research-post-approval-safety-monitoring-patient-safety-tools#:~:text=FAERS%20is%20an%20FDA%20database,safety%20of%20FDA%2Dapproved%20products.

The drugs aren't "working" as should be clear from the reports I've referenced, in particular the NHS review, but also reviews from many other European countries, including the Netherlands which has repudiated the original "Dutch protocol" which started this whole horror show off.

Last time I looked, puberty blockers are still reliably blocking puberty so they are "working" in a technical sense.

The "Dutch protocol" is something that is definitely worth discussing but the elephant in the room is actually this:

A detransitioning rate of 1% or less as reported in the past is worrisome but not for the reason one might presume.
When compared with other medical/surgical interventions it is an extremely low "regret rate" which seems to be moving to a more comparable level.

When confronted with such an extremely low "regret rate", one has to ask if the criteria used to make the indication for transitioning are possibly too narrow - meaning that a lot of patients are going untreated because practitioners are excessively trying to stay on the safe side.

The revision of the "Dutch protocol" has lowered the threshold for treatment but there is a legitimate discussion to be had if it was done in the right way - not a simple undertaking at all.

No-one, not even me, is suggesting that someone can't transition as an adult.  So if the criteria for child transition are too narrow (and I've provided evidence of children being prescribed puberty blockers/trans sex hormones on as little as one 9 minute "consultation") that can be resolved by transitioning on adulthood.

[Psychstache]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

So, is part of your argument that you don't believe that psychiatry is a branch of medicine?

[PeteD01]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

So, is part of your argument that you don't believe that psychiatry is a branch of medicine?

The underlying belief is that the problem doesn't really exist or at least is not of such concern that medical treatment should be available to children with gender dysphoria.

The trouble with this is that the only ones that can make the determination if the risks and side effects of hormonal treatment are outweighed by the benefit to the patient is the patient and the family in consultation with medical/psychological experts.
 

[former player]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

So, is part of your argument that you don't believe that psychiatry is a branch of medicine?

The underlying belief is that the problem doesn't really exist or at least is not of such concern that medical treatment should be available to children with gender dysphoria.

The trouble with this is that the only ones that can make the determination if the risks and side effects of hormonal treatment are outweighed by the benefit to the patient is the patient and the family in consultation with medical/psychological experts.

The psychiatric basis for gender dysphoria is indistinguishable from the psychiatric basis for anorexia: both are a belief in the mind that the physical body is "wrong" in some way that physical examination cannot prove.  Anorexia isn't treated by saying "oh yes, you are obese, lets staple your stomach", why should gender dysphoria be treated by changing the body?  Particularly given that informed consent is not always properly obtained and the physical consequences can be lifelong and devastating.  The medical "experts" have often been as led astray by trans rights activists, the tic tok memes and the resulting public opinion as the rest of us have, and many of them cannot be trusted - as would be clear to anyone who reads the WPATH files or the stories of detransitioners.

[PeteD01]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

So, is part of your argument that you don't believe that psychiatry is a branch of medicine?

The underlying belief is that the problem doesn't really exist or at least is not of such concern that medical treatment should be available to children with gender dysphoria.

The trouble with this is that the only ones that can make the determination if the risks and side effects of hormonal treatment are outweighed by the benefit to the patient is the patient and the family in consultation with medical/psychological experts.

The psychiatric basis for gender dysphoria is indistinguishable from the psychiatric basis for anorexia: both are a belief in the mind that the physical body is "wrong" in some way that physical examination cannot prove.  Anorexia isn't treated by saying "oh yes, you are obese, lets staple your stomach", why should gender dysphoria be treated by changing the body?  Particularly given that informed consent is not always properly obtained and the physical consequences can be lifelong and devastating.  The medical "experts" have often been as led astray by trans rights activists, the tic tok memes and the resulting public opinion as the rest of us have, and many of them cannot be trusted - as would be clear to anyone who reads the WPATH files or the stories of detransitioners.

Anorexia nervosa and body dysmorphic disorder have commonalities as  distortions of body image are present in many anorexia patients.

Gender dysphoric patients do not have body image distortions and that makes your notion a false analogy.

It is not hard to figure out that gender dysphoria and anorexia are fundamentally different.

[GuitarStv]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Do you rail as hard against kids with asthma puffers?  Albuterol is a super common off-label drug given to kids 2-12.

Asthma puffers 1) ameliorate an objectively known adverse medical condition, 2) do not otherwise change a child's physical development and 3) have no known long-term adverse physical effects.  Again, really not comparing like with like.

So if I understand your complaint correctly then, it very narrowly applies to products that have known long term physical effects which are approved for kids treatment of some psychological problems (precocious puberty) but not approved and used off label for treatment of other psychological problems (gender dysmorphia)?

This is a suspiciously oddly specific concern.

Precocious puberty is a physical problem not (or not only) a psychological one.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415463/

There exist brain differences in people who have gender dysphoria - which would mean that it's (at least partly) a physical problem.  So I'm not seeing the line of differentiation that you're drawing here.

Dear dog, the opening paragraphs tell me that paper is a mess.

"When research has been conducted in people with Androgen Insensitivity Syndrome, a condition where the testosterone receptor is mutated and faulty, and thus cannot function, gender dysphoria is observed as the body is genetically male but anatomically female. "
Androgen Insensitivity Syndrome is not "gender dysphoria", it is a difference in sexual development (DSD) in which people are identified as and grow up as female and are often only identified as having a DSD in relation to fertility issues. It has nothing to do with "gender dysphoria".  For a paper to make such a fundamental error discredits the whole thing.  There is also nothing in the paper that controls either for natural variations in masculinity and femininity in males and females or for homosexuality, particularly in feminine gay men and masculine lesbians: there is unfortunately, in a homophobic society, a current trend in which it can be socially easier for children to identify as trans rather than gay or lesbian, and there is also a sad incidence of homophobic parents (and possibly also homophobic doctors) preferring to trans kids into being heterosexual rather than remain as gay in their birth sex.

The paper literally describes people who have gender dysphoria for physical rather than psychological reasons.  Androgen Insensitivity Syndrome often causes someone to feel that their visible biological sex does not match the gender they feel - this is literally the definition of Gender Dysphoria.

It's not the case that all people with GD have this particular problem, but not all people with precocious puberty have physical problems requiring treatment - sometimes treatment is done for psychological reasons.  This really makes it seem that the two conditions are very similar, and I don't understand the (seemingly arbitrary) line you're drawing between the two.

[former player]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

So, is part of your argument that you don't believe that psychiatry is a branch of medicine?

The underlying belief is that the problem doesn't really exist or at least is not of such concern that medical treatment should be available to children with gender dysphoria.

The trouble with this is that the only ones that can make the determination if the risks and side effects of hormonal treatment are outweighed by the benefit to the patient is the patient and the family in consultation with medical/psychological experts.

The psychiatric basis for gender dysphoria is indistinguishable from the psychiatric basis for anorexia: both are a belief in the mind that the physical body is "wrong" in some way that physical examination cannot prove.  Anorexia isn't treated by saying "oh yes, you are obese, lets staple your stomach", why should gender dysphoria be treated by changing the body?  Particularly given that informed consent is not always properly obtained and the physical consequences can be lifelong and devastating.  The medical "experts" have often been as led astray by trans rights activists, the tic tok memes and the resulting public opinion as the rest of us have, and many of them cannot be trusted - as would be clear to anyone who reads the WPATH files or the stories of detransitioners.

Anorexia nervosa and body dysmorphic disorder have commonalities as  distortions of body image are present in many anorexia patients.

Gender dysphoric patients do not have body image distortions and that makes your notion a false analogy.

It is not hard to figure out that gender dysphoria and anorexia are fundamentally different.

The similarity is that the patient's mind thinks one thing and their body demonstrates another that is completely opposite.

[former player]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Do you rail as hard against kids with asthma puffers?  Albuterol is a super common off-label drug given to kids 2-12.

Asthma puffers 1) ameliorate an objectively known adverse medical condition, 2) do not otherwise change a child's physical development and 3) have no known long-term adverse physical effects.  Again, really not comparing like with like.

So if I understand your complaint correctly then, it very narrowly applies to products that have known long term physical effects which are approved for kids treatment of some psychological problems (precocious puberty) but not approved and used off label for treatment of other psychological problems (gender dysmorphia)?

This is a suspiciously oddly specific concern.

Precocious puberty is a physical problem not (or not only) a psychological one.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415463/

There exist brain differences in people who have gender dysphoria - which would mean that it's (at least partly) a physical problem.  So I'm not seeing the line of differentiation that you're drawing here.

Dear dog, the opening paragraphs tell me that paper is a mess.

"When research has been conducted in people with Androgen Insensitivity Syndrome, a condition where the testosterone receptor is mutated and faulty, and thus cannot function, gender dysphoria is observed as the body is genetically male but anatomically female. "
Androgen Insensitivity Syndrome is not "gender dysphoria", it is a difference in sexual development (DSD) in which people are identified as and grow up as female and are often only identified as having a DSD in relation to fertility issues. It has nothing to do with "gender dysphoria".  For a paper to make such a fundamental error discredits the whole thing.  There is also nothing in the paper that controls either for natural variations in masculinity and femininity in males and females or for homosexuality, particularly in feminine gay men and masculine lesbians: there is unfortunately, in a homophobic society, a current trend in which it can be socially easier for children to identify as trans rather than gay or lesbian, and there is also a sad incidence of homophobic parents (and possibly also homophobic doctors) preferring to trans kids into being heterosexual rather than remain as gay in their birth sex.

The paper literally describes people who have gender dysphoria for physical rather than psychological reasons.  Androgen Insensitivity Syndrome often causes someone to feel that their visible biological sex does not match the gender they feel - this is literally the definition of Gender Dysphoria.

It's not the case that all people with GD have this particular problem, but not all people with precocious puberty have physical problems requiring treatment - sometimes treatment is done for psychological reasons.  This really makes it seem that the two conditions are very similar, and I don't understand the (seemingly arbitrary) line you're drawing between the two.

Not "often" at all: a "few" cases in the UK in older children and adults.

https://www.nhs.uk/conditions/androgen-insensitivity-syndrome/

Precocious puberty (ie before the age of 8) is more common in girls, and the main cause of distress is managing periods, a physical symptom.

[GuitarStv]

Prescribing off-label is common practice to the tune of about one third of prescriptions in the US and is an accepted reality in US medicine - there is nothing to see here.

That might be one of the reasons that 2.2 million people experience adverse drug reactions (ADRs) in the USA each year and the (reported) death due to ADRs is 783,936.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060929/

Not really a good argument for giving kids unapproved drugs for unapproved purposes, in my view.

Do you rail as hard against kids with asthma puffers?  Albuterol is a super common off-label drug given to kids 2-12.

Asthma puffers 1) ameliorate an objectively known adverse medical condition, 2) do not otherwise change a child's physical development and 3) have no known long-term adverse physical effects.  Again, really not comparing like with like.

So if I understand your complaint correctly then, it very narrowly applies to products that have known long term physical effects which are approved for kids treatment of some psychological problems (precocious puberty) but not approved and used off label for treatment of other psychological problems (gender dysmorphia)?

This is a suspiciously oddly specific concern.

Precocious puberty is a physical problem not (or not only) a psychological one.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7415463/

There exist brain differences in people who have gender dysphoria - which would mean that it's (at least partly) a physical problem.  So I'm not seeing the line of differentiation that you're drawing here.

Dear dog, the opening paragraphs tell me that paper is a mess.

"When research has been conducted in people with Androgen Insensitivity Syndrome, a condition where the testosterone receptor is mutated and faulty, and thus cannot function, gender dysphoria is observed as the body is genetically male but anatomically female. "
Androgen Insensitivity Syndrome is not "gender dysphoria", it is a difference in sexual development (DSD) in which people are identified as and grow up as female and are often only identified as having a DSD in relation to fertility issues. It has nothing to do with "gender dysphoria".  For a paper to make such a fundamental error discredits the whole thing.  There is also nothing in the paper that controls either for natural variations in masculinity and femininity in males and females or for homosexuality, particularly in feminine gay men and masculine lesbians: there is unfortunately, in a homophobic society, a current trend in which it can be socially easier for children to identify as trans rather than gay or lesbian, and there is also a sad incidence of homophobic parents (and possibly also homophobic doctors) preferring to trans kids into being heterosexual rather than remain as gay in their birth sex.

The paper literally describes people who have gender dysphoria for physical rather than psychological reasons.  Androgen Insensitivity Syndrome often causes someone to feel that their visible biological sex does not match the gender they feel - this is literally the definition of Gender Dysphoria.

It's not the case that all people with GD have this particular problem, but not all people with precocious puberty have physical problems requiring treatment - sometimes treatment is done for psychological reasons.  This really makes it seem that the two conditions are very similar, and I don't understand the (seemingly arbitrary) line you're drawing between the two.

Not "often" at all: a "few" cases in the UK in older children and adults.

https://www.nhs.uk/conditions/androgen-insensitivity-syndrome/

Precocious puberty (ie before the age of 8) is more common in girls, and the main cause of distress is managing periods, a physical symptom.

Sure.

But it does happen.  As with psychological treatment of precocious puberty.

So this would seem to negate the main argument you've been making against access to puberty blockers for trans youth.  Unless you're now changing it to argue against use of puberty blockers for those with precocious puberty as well?

[PeteD01]

puberty blockers which are also untested for cross-sex purposes and prescribed off-label, and which also have serious and irreversible long term effects, being given to children, some as young as 11 or 12, who cannot possibly fully understand the implications for their adult lives, and the same goes for surgery on underage children too.

I realise that the debate on these issues has become party political, and think that has only acted to obscure reasoned debate and draw false lines on both sides that help no-one.

Given that less than 50% of available medication has pediatric testing (), off-label prescriptions for children are extremely common and normal.  Are you only against off-label use of puberty blockers, or do you also have an issue with the 26-50% of all pediatric prescriptions (based on this study here - [url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6677268/) that are given off-label?

FWIW, I believe that we should have the best evidence possible when prescribing any medication to anyone.  But when there is a clear need, it's difficult to argue that the patient should be forced to suffer while waiting for testing that may not be available for decades (or ever).

Those drugs have at least been tested and approved on adults, are being used for an approved purpose, have a clear medical (rather than psychiatric) purpose, and do not make permanent changes with adverse consequences to an otherwise healthy body.  So not really the same thing.

So, is part of your argument that you don't believe that psychiatry is a branch of medicine?

The underlying belief is that the problem doesn't really exist or at least is not of such concern that medical treatment should be available to children with gender dysphoria.

The trouble with this is that the only ones that can make the determination if the risks and side effects of hormonal treatment are outweighed by the benefit to the patient is the patient and the family in consultation with medical/psychological experts.

The psychiatric basis for gender dysphoria is indistinguishable from the psychiatric basis for anorexia: both are a belief in the mind that the physical body is "wrong" in some way that physical examination cannot prove.  Anorexia isn't treated by saying "oh yes, you are obese, lets staple your stomach", why should gender dysphoria be treated by changing the body?  Particularly given that informed consent is not always properly obtained and the physical consequences can be lifelong and devastating.  The medical "experts" have often been as led astray by trans rights activists, the tic tok memes and the resulting public opinion as the rest of us have, and many of them cannot be trusted - as would be clear to anyone who reads the WPATH files or the stories of detransitioners.

Anorexia nervosa and body dysmorphic disorder have commonalities as  distortions of body image are present in many anorexia patients.

Gender dysphoric patients do not have body image distortions and that makes your notion a false analogy.

It is not hard to figure out that gender dysphoria and anorexia are fundamentally different.

The similarity is that the patient's mind thinks one thing and their body demonstrates another that is completely opposite.

No, not at all.

Gender dysphoria is not even a disorder whereas anorexia and body dysmorphic disorders are recognized mental disorders in the obsessive compulsive spectrum.

Gender dysphoria does not involve distortions of body image whereas this is common in anorexia and disease defining in body dysmorphic disorder.

Gender dysphoria may be causally related to mental disorders such as depression, anxiety etc.
Psychologic/psychiatric treatment of patients with gender dysphoria is therefore not directed at the gender dysphoria but at the mental health comorbidities.

The conditions are so fundamentally different that gender reassignment is a commonly successful treatment as it directly addresses the cause of gender dysphoria, which is an identity conflict, whereas performing corrective surgeries or support of starvation strategies in body dysmorphic disorder and anorexia respectively are contraindicated.

And you want to tell people how to deal with their children?

[former player]

This discussion is getting into the medical weeds and is a long way from my original post. 

https://forum.mrmoneymustache.com/off-topic/does-anyone-regret-voting-republican-133804/msg3243505/#msg3243505

No-one has provided evidence to counteract the NHS view that the primary treatment for gender dysphoria in children should be psychosocial and psychological support, not drugs, for which there is no good evidence.

The evidence that drugging children with gender dysphoria can lead to losses in IQ is not strong but it's a big risk to take if it's right and there is no evidence against it.

Odd that no-one has had anything to say about the WPATH files, right?  Not even a scintilla of concern?  The protocols for medical treatment of gender dysphoria in children are almost all based on their activism, and they are a bunch of crooks and fetishists, some of whom apparently get sexual pleasure from the thought of castrating young boys.

https://environmentalprogress.org/big-news/wpath-files

These are not the people whose side anyone should want to be on without excellent independent evidence that they are right - and no such evidence exists.

We've all been conned for too long.  If you want to know how we all got here, there has been big money behind it, including from the adult trans owner of a medical supplies company -

https://thefederalist.com/2018/02/20/rich-white-men-institutionalizing-transgender-ideology/


Read this document, written by one of the biggest and most expensive law firms in the City of London, to see how lobbying for the life-long medicalisation of children has astroturfed those ideas into the political space -

https://gendercriticalwoman.files.wordpress.com/2020/07/iglyo_v3-1.pdf

[former player]

And now I have to go and do some local activism in the real world.  Peace out (for tonight).

[GuitarStv]

Odd that no-one has had anything to say about the WPATH files, right?  Not even a scintilla of concern?  The protocols for medical treatment of gender dysphoria in children are almost all based on their activism, and they are a bunch of crooks and fetishists, some of whom apparently get sexual pleasure from the thought of castrating young boys.

https://environmentalprogress.org/big-news/wpath-files

These are not the people whose side anyone should want to be on without excellent independent evidence that they are right - and no such evidence exists.

Have you read the actual content discussed in the WPATH files, or just the summary (given by Mia Hughes/Mia Sedley/Mia Ashton, a very prolific British anti-trans activist who writes under many different names)?  I skipped the commentary and checked out the source material - and didn't really find anything terribly awful while skimming through.  It's a series of discussions by medical professionals about treating trans patients.

There are 140 pages of internet forum posts, created by anyone who paid 225$ to join the WPATH private forum.  The names of the posters are almost entirely redacted, giving no idea who was making these comments.  In many cases it seems that the main post that is being discussed was left out of the document.  Can you specify which posts exactly you're most concerned about, who made them, and why they concern you?

There are also 31 pages transcribing a WPATH video discussion that was held about informed consent where the informed consent process had broken down, resulting in patients or parents who lacked a full understanding of what treatment would entail. These stories and discussion of where the process broke down was being used as a teaching aid to explain the importance of making sure that patients and parents fully understood what the clinician had explained.  Again, could you specify what exactly was most concerning to you here?

EDIT - Don't get me wrong, I have no particular love for WPATH and didn't know anything about them until seeing your link earlier.  I just don't really see anything to get outraged about here - but maybe I missed something.