World Professional Association for Transgender Health (WPATH) Files

As so often, Jack, it's impossible to work through your posts in any detail, so the fact that I've ignored all but the bit below does not signify either agreement or disagreement. I just haven't really read it, TBH.

But this bit jumped out at me:

Being able to use the bathroom of their preference is a basic right which supports every child’s right to an education, no different than their equal participation in sports is supportive of their right to an education.

Being able to do something because you prefer is not a basic right. I'm not entitled to use the disabled toilets because I don't want to join the queue for the ladies, nor even because I feel that my advancing age should entitle me to when I have no actual disabilities caused by age.

Similarly "equal participation in sports" - males taking part in female sports is not "equal participation" - indeed it excludes females.

As so often, Jack, it's impossible to work through your posts in any detail, so the fact that I've ignored all but the bit below does not signify either agreement or disagreement. I just haven't really read it, TBH.

And you know I wouldn't have it any other way 😁

Being able to do something because you prefer is not a basic right. 

That's not what I said though?

I'm not entitled to use the disabled toilets because I don't want to join the queue for the ladies, nor even because I feel that my advancing age should entitle me to when I have no actual disabilities caused by age.

volchista you're entitled to use whatever toilet you prefer, without feeling any need whatsoever to explain yourself or justify your actions to anyone. There's no catch, there's no need to "surprise" anyone with the revelation that girls actually do piss, poop, and fart just like everyone else, y'know, you just… do you!

And that's why, similarly, as you put it - schools are not permitted to treat students less favourably on the basis that they are transgender:

In summary, we hold that Dallas School District No. 2’s carefully-crafted Student Safety Plan seeks to avoid discrimination and ensure the safety and well-being of transgender students; it does not violate Title IX or any of Plaintiffs’ cognizable constitutional rights. A policy that allows transgender students to use school bathroom and locker facilities that match their self-identified gender in the same manner that cisgender students utilize those facilities does not infringe Fourteenth Amendment privacy or parental rights or First Amendment free exercise rights, nor does it create actionable sex harassment under Title IX. Accordingly, Plaintiffs have failed to state a federal claim upon which relief can be granted. The judgment of the district court is AFFIRMED.

18-35708.pdf (uscourts.gov)

I'm sure what you meant to say was that you emailed the school in advance… etc.

You can be as sure as you like, but I didn't mean to say that, because I didn't do that. I try to be as factually correct as I can in my posts. Now, it was over 20 years ago, so I'm not 100% sure of the details, however I am 100% sure that I didn't contact the school at all. Myself and his mother supported him in contacting the school - he initiated the contact by suggesting that he attend school during our vacation, and we adjusted our planned travel dates to accommodate that request. As I recall he emailed the teacher (with our help), most likely by using a generic school email. At any rate the reply came from the teacher. But none of the above negates the point I was making, which was that he had such a positive experience during his school attendance when we were resident in Oregon, that he wanted to attend again. My mentioning of the schoolteacher providing her home number to parents for the convenience of parents was making a separate point about how seriously this teacher took her obligations to do everything she could to provide a good education. You chose to twist my words to make a point about teachers being inappropriately familiar with kids. Nothing could have been further from the actual situation - the school was run very professionally, there was a high standard of discipline (absent random beatings by psychopaths), oh, and as local taxpayers everything was provided, even the copies - none of this (in)voluntary contribution nonsense. Now, I suppose I could have made a proper, unambiguous, detailed post, including what we'd all had for breakfast, the serial number and date of manufacture of the computer the email was typed on, and the weather conditions at the time, but no doubt you'd have found fault with that, whether due to arseholery or some other reason.

Now, if the above paragraph seems off topic, there is one thing I remember that is pertinent to the current debate. My son was generally well behaved, and rarely generated any negative comments from teachers. One day he came home Oregon school and announced that he had gotten a tardy slip, as he had been a couple of minutes late. It was a big deal. Nowadays such a focus on punctuality would be seen as white supremacy, and that in turn is another aspect of the DEI religion that has infiltrated all sorts of public organisations and led us to the current mess. Thankfully there are signs that the pendulum is beginning to swing in the opposite direction, albeit slowly.

Regarding your second point, I don't know what you are trying to say - what is it that I am mistaken about? I could paste a chunk of Jesse Singal's article, but another poster kindly linked it and it's easily found if anyone feels the need. Suffice it to say that Singal has clearly laid out the many ways in which Meredithe McNamara has misled people regarding her experience, in such a way as to cast serious doubt on her own credibility and the credibility of the Yale report you linked, and that she submitted as an affadavit:

Btw Singal has decided that rather than just a second part, he needs a three part article to discuss the Yale critique properly - again the material is easily found.

What I intended to say is exactly what I said, is exactly what you quoted:

Being able to use the bathroom of their preference is a basic right.

I didn’t say being able to do something because you prefer is a basic right, as if that applies to anyone and anything.

It doesn’t come as a surprise at all that’s what anyone believes about those door signs on bathrooms, but that’s all they are, is an indicator, not an order. Anyone can use whatever facilities are most comfortable for them, or convenient for them, whatever.

That’s what the case in Dallas was about - that a child who is transgender is permitted to use whatever bathroom they prefer, in the same manner as every child has that right. The parents and others who objected, sought to deprive children of the same rights as every child are entitled to. They failed to make their case. The outcome wouldn’t be any different in Ireland, but I’ve never heard of a school where it’s become an issue for the Courts yet - children use whatever bathroom they prefer and that’s about it, no fuss or melodramatics.

Singal hasn’t done any such thing. All he’s done is repeated other people’s accusations which is their opinion, based upon their reading of the affidavit provided by McNamara, which you’ve suggested is indicative of credibility issues on the part of McNamara, thereby meaning the report itself lacks credibility. You haven’t at all engaged with the substance of the report, what you actually did was make the point that you had seen comments that the Cass Review was this, that and the other, which is why I provided the actual report, and a critical commentary on the biological and psychosocial evidence in the Cass Review, which you didn’t engage with either:

https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2362304

You shouldn’t expect anything from the authors of the report, better, worse or otherwise, especially when in the very first lines of the report, right after the authors listed and acknowledgements of several contributing authors, they make this very clear:

This work reflects the views of individual faculty and does not represent the views of the authors’ affiliated institutions.

The authors and contributors include:

Meredithe McNamara, MD MSc, Assistant Professor of Pediatrics, Yale School of Medicine

Kellan Baker, PhD, MPH, MA, Executive Director, Whitman-Walker Institute

Kara Connelly, MD, MCR, Associate Professor of Pediatrics, Division of Endocrinology, School
of Medicine, Oregon Health & Science University

Aron Janssen, MD, Associate Professor of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine

Johanna Olson-Kennedy, MD, Professor of Clinical Pediatrics, Keck School of Medicine of
University of Southern California

Ken C. Pang, FRACP, PhD. NHMRC Leadership Fellow and Senior Principal Research Fellow,
Murdoch Children’s Research Institute, VIC Australia

Ayden Scheim, PhD, Assistant Professor of Epidemiology, Dornsife School of Public Health,
Drexel University

Jack Turban, MD, MHS, Assistant Professor of Psychiatry & Behavioral Sciences and Affiliate
Faculty at the Philip R. Lee Institute for Health Policy Studies, University of California, San
Francisco

Anne Alstott, JD, Professor of Law, Yale Law School

We would like to thank Richard Body, MB ChB, MRCSEd (A&E), FRCEM, PhD and Annelou de Vries, MD, PhD for their expert feedback on drafts of this report. We would also like to thank Jay Taimish, Colin Kim, Paola Vidal-Espinoza, and Schuylar Bailar for their excellent research support.

https://law.yale.edu/sites/default/files/documents/integrity-project_cass-response.pdf

You’re hanging your hat on Singal’s efforts at nit-picking, misdirection and repeating another bloggers deliberate attempt to discredit McNamara by claiming her statements in an affidavit are misleading, false or perjurous even, without actually stating what statements he is referring to that he claims are misleading, etc. Your original point was that you hadn’t seen evidence of any substantive criticism of the Cass Review, my point was simply to present you with evidence of substantive criticism of the Cass Review. I couldn’t give a damn what Singal has to say about anything.

In a similar fashion, you presented the video earlier and posed the question as to why Maud Marron had a ton of shìt coming down on her head, and I presented evidence as to why Maud Marron had a ton of shìt coming down on her head, to which you responded that you didn’t expect anyone would actually watch the video. Why wouldn’t anyone watch the video? It didn’t amount to anything substantial in any case, worst part was Stella O’ Malley claiming she didn’t understand the Irish exam grading system that’s been in existence since 2015, while she claims an interest in youth mental health and well-being. She was talking to a woman who had tried to fight against the entrance exams in Stuyvesant High School being done away with because she wanted the school to remain an elitist institution, Marron decrying what she perceived as the demise of the New York State education system.

You then complained about my response being ‘a wall of text’, but that’s generally the format of a discussion forum, as opposed to a platform like twitter which lends itself quite nicely to sniping, goading and shìtposting, if that’s more your thing. As an engineer I don’t imagine it is, and it shouldn’t be any difficulty for you to read and understand a short post of a few paragraphs, never mind a three page blog post, a 39 page report, or even the Cass Review - a nearly 400 page review with supplementary material. I don’t complain as though I’m being forced to read anything, I do so by choice, and so do you and anyone else who is choosing to contribute to the discussion regarding the provision of healthcare for children who are transgender. Part of that discussion is inevitably centred around their participation in education as it is the right of every child to be entitled to that opportunity because it contributes to their overall health and mental well-being.

Only a vanishingly small number of adults appear to have difficulty with that concept, generally those adults who are more concerned with themselves and their own ideas for how a society should be structured and governed, than seeking to engage with reality, which is how they come up with silly ideas like the recommendations in the Cass Review in the UK, knowing the NHS as it is, and the waiting lists for paediatric care, is in this condition:

https://www.rcpch.ac.uk/news-events/news/record-high-over-400000-children-waiting-treatment-amidst-child-health-crisis

Quite a few things to deal with:

That’s more like it, and with a bit of humour too, always a bonus! 😊

Yes, as an engineer, there’s no way to avoid a fair bit of reading. However I’m lucky in that most of the stuff I have to deal with relates to things that can be independently verified by internationally agreed methods. I don’t get to dismiss stuff out of hand – if I need a certain result for my project to proceed, and I find information that conflicts with that, then I can’t just say “that’s not true” without providing evidence, or “that’s true but it’s nothing to do with anything”. I can’t just say I don’t give a sh1t about what someone else thinks if they have provided a critique worthy of consideration - I'd have to say why.

You can, you must, or you’d spend considerable resources going down rabbit holes, when all that is in question is your capacity to focus your attention long enough to read and understand a couple of paragraphs. You’ve demonstrated, as I suspected by virtue of you being an engineer, you are capable of being able to do so. That’s all I needed to know. Without meaning to be rude – the extra clarification again just isn’t necessary.

When you said that “Cass got the result the NHS desired”, did you mean that she set out with a particular outcome in mind?

I mean that Cass understood the assignment. The NHS, those who commissioned Cass to chair the Review, had a particular outcome in mind, and they set the parameters, or terms of reference and the scope of the review, and determined that Cass was a suitable candidate (she was the only candidate considered!) for the role of Chair of the Review. Cass delivered exactly what was expected of her – she got the results the NHS desired. She had to set out with a particular outcome which was given to her and had to work within the constraints which would lead to that outcome.

Again, regarding Cass, you said:

“She was under no obligation whatsoever, moral, professional or otherwise, to attempt to influence the review process in which her participation was not requested”.

Here’s the gist of her letter:

“It was outside the Review’s remit to attempt to validate the accounts I received, or to determine whether all the issues are still current. In addition, practice and standards may be markedly different between different clinics. However, there were common themes which I hope will be explored in the upcoming review of adult gender services that NHS England is planning to undertake. “

She then lists the various concerns that have been raised to her, before finishing:

“I hope this is helpful to NHS England as it embarks on the review of adult services.”

The first bit I bolded shows that she is very clear in what her remit was. Hoping something will be explored and hoping the information she has provided will be helpful are hardly signs of an attempt to influence a process – if you believe she was trying to influence the process then you’d have to accept the argument that withholding the information would equally be an attempt to influence the process. There’s nothing in her letter suggesting what form the review process should take, or what the desired outcome should be, so your attempt to attribute improper conduct to her falls a bit flat.

I don’t have to accept the argument that withholding the information would equally be an attempt to influence the process, not only because that’s a sloppy argument, but because you’ve left out the contents of the letter which formed the basis of her comments, those claims which she presented without evidence, which I also pointed out was a feature of the review – rife with claims which lacked evidence, something I noted on reading the review long before I read the critiques which pointed out the lack of evidence for many of the claims in the review. The only reason she couldn’t influence the process of a review of adult gender services is because the NHS reminded her in the most diplomatic terms that her services are no longer required.

You asked: “Does it occur to you that critics of the review too have a moral, ethical or professional obligation to do so? “

They do, it’s open to anyone who has concerns to raise them through any forum they have access to, however there are a number of problems with the Yale document. You’ve listed the authors, and stated how the views are their own, but given that the document is posted on the Integrity Project section of the Yale Law School website, it does look like they are trying to benefit from the reputation of that institution. Given that, and the “Integrity” bit, I would have expected them to disclose the following conflicts of interest, but no such disclosure appears at the beginning or end of the document. From Singal:

“Let’s start with some of the authors’ roles as paid expert witnesses for parties fighting American bans or restrictions on youth gender medicine: McNamara ($400per hour), Janssen ($400per hour), Olson-Kennedy ($200per hour), and Turban ($400or $250 per hour, depending on the task) have all received money as expert witnesses in cases fighting bans or restrictions of youth gender medicine in American states. If someone gets paid as an expert witness, does that mean we should never trust them? Of course not. But it does mean that they need to disclose this when appropriate ,especially when they are touting the “transparency” of their work. In other cases, co-authors on this document also have consulting and textbook royalty income riding directly on the continuing availability of youth gender medicine, which of course also bears mentioning.

Moreover, multiple studies published by Turban were rated as low quality by the Cass team’s systematic reviewers. One of Turban’s studies (footnote 53) was deemed low quality in the SR on puberty blockers; another(footnote 65) was deemed low quality in the SR on hormones (if you’re a subscriber to this newsletter, the weaknesses of these studies will not come as a surprise). Three of Olson-Kennedy’s studies were rated “moderate” in the puberty blocker and hormones SRs. This warranted disclosure as well, because readers have a right to know about these sorts of conflicts: Here Turban is co-authoring a searing assessment of a project that rated his own work poorly. Guyatt agreed that the expert witness, royalty, consulting, and authorship conflicts should have been disclosed. 

Finally, there’s the simple fact that a number of the authors work in gender clinics. They tout this rather than hide it (albeit without mentioning, by name, who works in gender clinics), and to be fair, this isn’t usually considered a conflict of interest. But it really should be: If you work in a youth gender clinic, you are obviously conflicted when it comes to evaluating a document that rates the evidence for youth gender transition poorly! How can anyone even contest this? I asked Guyatt and he agreed both that this isn’t usually seen as a conflict and that it should be.”

I never thought I’d reference Warren Buffet on this thread, but all the above seems a lot like barbers telling us we need haircuts (that advice would be particularly redundant in my case 😀).

The reason I made that point is because initially you presented the critique in the interests of fairness or balance, and said that it pointed out ways in which the Cass review could have done better, and then later you made the point that you’d seen comments that didn’t amount to anything substantial, but when I provided that review and the other commentary I provided (they were the most relevant as they examine the evidence used in the Cass review in support of its recommendations), that’s when you introduced Singal’s critique of a critique. It’s then that I pointed out Singal’s and another bloggers efforts to discredit the authors of the review amounted to nothing. They still don’t.

The Yale document is also full of self-contradictory stuff: first they decry the Cass review for mentioning GRADE but not sticking rigidly to its evidence quality terminology:

“Under GRADE, quality designations such as “high,” “moderate,” “low,” and “very low” are used to describe evidence. There is a shared understanding of what these terms mean in medical science, which allows experts to use them in developing clinical recommendations for broad application.

The Review introduces GRADE (p 55) but never evaluates the evidence using the GRADE framework. The Review borrows GRADE terminology in repeatedly expressing a desire to see “high quality” evidence dominate the field of transgender health. Thus, the Review falls seriously short in not describing or applying a formal method for assigning evidence quality. Thus, the Review speaks a language that may seem familiar, but its foundations are pseudoscientific and subjective. For instance, unscientific evidence quality descriptors such as “weak” and “poor” were identified 21 times and 10 times respectively.”

Then they cast doubt on the utility of evidence quality terminology:

“The usefulness of evidence quality terminology is thoughtfully debated in the medical community. Different assessors often disagree and make divergent evidence quality assessments. There are no well-described processes by which such disagreements should be resolved.”

Another contradiction pasted directly from Singal’s blog: (page15 of the report)

What they’re casting doubt on, is the fact that the review falls short of applying a formal methodology for assigning evidence quality, instead using language that is pseudoscientific and subjective. Where you suggest they cast doubt on the utility of evidence quality terminology is not what they’re doing – they’re making the point that there are different standardised ways to assess the quality of evidence, and that while the Cass review gives a passing mention to GRADE, it uses it’s own customised interpretation of a combination of MMAT and Newcastle-Ottawa scale tools, and there are no well-described processes by which divergent evidence quality assessments which come from the use of each tool, should be resolved. That’s not a contradiction, it’s a statement of fact.

“Wait, I thought you weren’t allowed to say “long-term” without specifying “exactly” what is meant by it? For the record, here’s the amount of space between McNamara and her colleagues complaining about that construction and using it:”

I’d be disappointed with a Junior cert student who presented such a sloppy argument.

I’d be as disappointed as you would be should a student at any level present such a sloppy argument, though I take it Singal’s argument is not the argument which you’re referring to. There is nothing in the report which suggests anyone isn’t allowed to say “long-term” without specifying “exactly” what is meant by it. The point the authors of the report are making is that Cass having excluded long-term data, claims there is no long-term data, and therefore the exclusion requires an explanation of exactly what conditions would satisfy the term “long-term data” as the term is used in the Cass review. Further, it goes on to make the point that by virtue of how they are used, and when they are used, long-term data on the use of puberty blockers would not at least be ethically possible to collect (puberty blockers by themselves are a short-term treatment), and further – the review expects for there to be an abundance of long-term data available from treatments that have only been more readily available for gender-affirming purposes over the last 10 years.

Singal’s argument is yet again an attempt to make something out of nothing.

You said “you responded that you didn’t expect anyone would actually watch the video”, when what I actually said was:

“Regarding the first link, I didn't expect anyone to actually watch / listen to all of it”  - you were being uncharacteristically economical with your verbiage, hopefully unintentionally, as there wouldn’t be much point in posting a link that I didn’t intend people to at least have a quick scan or browse at.

Since you mention Stella O’Malley, yes, she did say that she didn’t understand the grades, but she was mostly concerned about phrases like “meets expectations” on her kids’ report cards, when those expectations have not been clearly defined (maybe the Integrity Project wrote the reports 😀).

You’ve exceeded my expectations with your use of the term “uncharacteristically economical with your verbiage” (I’m writing that down 😁). It just seemed like you were surprised anyone watched any of it, let alone all of it. I did because I have no reason to assume you’re posting that crap in bad faith, so I figured I’d give you a fair shot. I’m being kind when I say it met expectations, indicating that I wasn’t at all concerned that Stella feels the need to pretend that she doesn’t understand what is meant by “meets expectations” on her children’s report cards.

Regarding Maud Maron, she was removed from the NYC Education council as a result of a message written in a private forum which related to a personal belief, but her troubles began when she proposed that female athletes should be invited to take part in a conversation on matters that would affect their sports. Her resolution was passed by 8 votes to 3, but the Chairman rescinded it. I don’t know if he was actually entitled to do that based on the board charter, but it seems profoundly undemocratic. At any rate it’s an illustration of the point I was making about people shutting down opposing voices rather than engaging in debate. In a democratic society (I know, it’s the US, so the quality of democracy is debatable) when faced with opinions you don’t agree with, I think the proper course of action is to come up with a better argument, and make that argument as passionately and articulately as you can, rather than trying to get the person stating the offensive opinions removed from the position they hold. Your posting of a Father Ted clip reminded me of the fate that befell Graham Linehan, merely for challenging the trans orthodoxy.

Nah man, Maud’s troubles began long before her latest bandwagon jumping attempt to promote her belief that the education system in NY is in decline –

In 2019, Maron and Yitin Chu formed Parent Leaders for Accelerated Curriculum and Education NYC (PLACE NYC) to oppose Bill de Blasio's attempts to shift away from screened middle and high schools. Maron served as co-president. PLACE argues that the city's schools are failing their students, that the city should redouble its focus on academics, and that racism does not contribute to the city's underperforming schools. Other parental groups have described it as shifting rightward.

Maud Maron - Wikipedia

Graham Linehan’s fate is not a consequence of merely challenging the trans orthodoxy either - Linehan’s fate is also a consequence of being unable to take criticism of his ideas. He tried to use the imbalance of power you referred to earlier in an attempt to silence his critics, resulting instead in bringing a ton of shít down on himself, rather like Maron attempting to use the imbalance of power to silence her critics, resulting in, well, exactly what you suggested.

From the document you linked, twice:

“Discussion

As a result, this also calls into question whether the Review is able to provide the evidence to substantiate its recommendations to deviate from the international standard of care for trans children and young people.”

Would the bit I bolded be referring to the WPATH guidelines by any chance?

Yes it would, in part, as you can read from both the Introduction and the Conclusion, in the document I linked twice, that we can agree you read at least once:

As researchers and pediatric clinicians with experience in the field of transgender healthcare, we read the Review with great interest. The degree of financial investment and time spent is impressive. Its ability to publish seven systematic reviews, conduct years’ worth of focus groups and deeply investigate care practices in the UK is admirable. We hoped it would improve the public’s awareness of the health needs of transgender youth and galvanize improvements in delivery of this care. Indeed, statements of the Review favorably describe the individualized, age-appropriate, and careful approach recommended by the World Professional Association for Transgender Health (WPATH) and the Endocrine Society. Unfortunately, the Review repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculation. Many of its statements and the conduct of the York SRs reveal profound misunderstandings of the evidence base and the clinical issues at hand. The Review also subverts widely accepted processes for development of clinical recommendations and repeats spurious, debunked claims about transgender identity and gender dysphoria. These errors conflict with well-established norms of clinical research and evidence-based healthcare. Further, these errors raise serious concern about the scientific integrity of critical elements of the report’s process and recommendations.

…

Conclusion The Cass Review was commissioned to address the failure of the UK National Health Service to provide timely, competent, and high-quality care to transgender youth. These failures include long wait times—often years—and resulting delays in timely treatment by skilled providers. Instead of effectively addressing this issue, however, the Review’s process and recommendations stake out an ideological position on care for transgender youth that is deeply at odds with the Review’s own findings about the importance of individualized and age-appropriate approach to medical treatments for gender dysphoria in youth,consistent with the international Standards of Care issued by the World Professional Association for Transgender Health and the Clinical Practice Guidelines issued by the Endocrine Society. Far from evaluating the evidence in a neutral and scientifically valid manner, the Review obscures key findings, misrepresents its own data, and is rife with misapplications of the scientific method. The Review deeply considers the possibility of gender-affirming interventions being given to someone who is not transgender, but without reciprocal consideration for transgender youth who undergo permanent, distressing physical changes when they do not receive timely care. The vast majority of transgender youth in the UK and beyond do not receive an opportunity to even consider clinical care with qualified clinicians—and the Review’s data demonstrate this clearly.

Finally, we can definitely agree that the health service in the UK, and Ireland and the US is in a mess at the moment. It might be best then to investigate the sudden rise in ROGD among teenage girls, so as to limit the extra load on already burdened services.

That would be chasing down a rabbit hole which has already been debunked many, many times already. Given it’s not a clinically recognised term, it remains solely within the domain of culture warriors like Singal and Shrier (numerous times her name is dropped into the conversation in the video you provided, but not remotely a concern), referenced under this section -

The Review reanimates the debunked notion of “social contagion”

Also referenced here in the other commentary I linked to:

Notably, Littman previously published a study on gender dysphoria in adolescents (Littman, Citation2018). This study was subsequently widely criticized for its flawed methodology (Ashley, Citation2020; Restar, Citation2020), leading to a substantial correction of the original manuscript (Littman, Citation2019). Littman’s work should therefore be considered with increased scrutiny, in particular regarding whether the methodology used to obtain the results is robust. Indeed, the cited study (Littman, Citation2021), as well as the second study cited in the Review (Vandenbussche, Citation2022) while discussing reasons for detransitioning, has similar methodological issues to the previous study: potentially biased recruitment practices. In both studies, participants were particularly recruited from online detransition-related groups, potentially artificially inflating the number of people with negative views about transitioning and gender affirmative care.

It really wouldn’t be the best use of limited resources to go down rabbit holes, but as for what the NHS are likely to do with the Cass Review, and the forthcoming adult review, it would seem they are determined to do exactly as they have done in other areas of the NHS… and expect different results:

I was elected to lead not to read - YouTube

The British Medical Association (BMA) has reversed its decision to call for a pause in implementing the recommendations of the Cass Review, the New Statesman can reveal. It follows intense criticism of the doctors’ union after this publication exposed its discussions regarding the rejection of the findings of Dr Hilary Cass’s independent review into gender identity services for children and young people…

… The BMA was the only major medical group in the UK to consider rejecting Cass. Supportive statements have been issued by the Royal College of GPs, the Royal College of Psychiatrists, the Academy of Medical Royal Colleges and the Association of Clinical Psychologists …

The doctors’ union has voted to retain a neutral position on the issue.

Link to BMA statement:

https://www.bma.org.uk/bma-media-centre/bma-confirms-support-to-undertake-its-evaluation-of-the-cass-review-from-a-position-of-neutrality

Sense is beginning to rear its head at last, I think.

The BMA was the only major medical group in the UK to consider rejecting Cass. Supportive statements have been issued by the Royal College of GPs, the Royal College of Psychiatrists, the Academy of Medical Royal Colleges and the Association of Clinical Psychologists. Many BMA members were dismayed, some resigning their membership in protest. Signatories to the letter accused the union of failing to follow an evidence-based approach to medicine. The letter, shown first to the New Statesman , criticised the process behind the BMA’s decision as “opaque and secretive” and said the motion did “not reflect the views of the wider membership, whose opinion you did not seek”.

Is it in any way possible we may be seeing the beginning of the rejection of this forced medicalisation of kids ?? Dare we hope ?

By forced sterilisation you mean medication and surgery so their bodies correspond to the sex they already feel themselves to be?

Because as I understand it, a lot of the complaints about transgender healthcare in Ireland and about the Cass report and so on, are that young people can't get this treatment? Yet here you are presenting this as "forced"?

Seems to me it can't be both: either it's an essential part of transgender healthcare, and thus a right, or it's a cosmetic procedure and in that case why is the taxpayer being expected to fund it?

Sorry Jack, I'm not following you at all. You appear to be contradicting yourself by saying

"The taxpayer doesn’t fund anything, the taxpayer pays their taxes. Government decides how public funds are allocated and spent on the provision of public services such as education and healthcare, as part of public policies."

Just because we don't decide how each individual cent is spent, doesn't mean we're not funding anything. I'd argue that we're funding everything.

It seems you agree, at least a bit:

"if anyone wants to argue about why are taxpayers funding anything - they aren’t. It’s politicians who make those sorts of decisions as to how public funds are to be spent and allocated, which is why they decided that there is better value for the taxpayer in funding treatments abroad rather than funding services to provide for the treatments in Ireland"

If the taxpayer is not funding anything, then how does the idea of better value for the taxpayer arise?

I recall you making a similar argument some years back in a different context. I think your logic fails - I agree that we have "outsourced" our spending decisions to the government, but that doesn't mean we aren't getting the bills just the same. If you hire a contractor to build a house for you, and he decides to use one type of screw rather than another, then you can be bloody sure you are paying for the screws either way. If we follow your logic to the end, then we didn't pay for the bike shed or the security hut, and we're all going to be very relieved to find the children's hospital isn't costing us a cent either😀!

Hopefully, now that the Tavistock is no more, although the contents the latest Irish school curriculum (SPHE) is only adding fuel to the fire by indoctrinating Irish kids into the ideology, which will encourage some to take the path to "transitioning" into something they can never be.

Interesting article, and important to say she won't actually be retransitioning to be female, because she never stopped being female, even if she "lived as a man".

Belgium for one:

Following the closure of the Tavistock to new patients, the HSE wrote to all 101 children who were on the service’s waiting list to advise them of a gender clinic in Belgium as a possible treatment option.

Unlike the Tavistock, the HSE does not formally refer patients to the Belgian clinic. It advised patients by letter about how to access care there. The Belgian clinic has treated fewer than five children from Ireland, according to the HSE.

This clinic told Prime Time that it operates in accordance with WPATH guidelines. We asked the HSE why it had picked this specific clinic even though it told Prime Time that "the quality of the care" at the clinic "was not assessed".

In its statement, the HSE said it "became aware" that this clinic "was accepting patients" under its public health system. It said it "does not recommend the service. It simply informs patients of the availability of that public service".

It also said it has "no role in evaluating or otherwise approving a public healthcare service in another EU/EEA country".

https://www.rte.ie/news/primetime/2023/1214/1422073-leading-doctors-complain-hse-to-hiqa-over-transgender-care/

I can’t see many adults bring their thirteen year old daughters to the USA to have their breasts removed.

I couldn’t either, to be honest. Poland is a lot closer, and a hell of a lot cheaper than the US! Still wouldn’t see that many parents bringing their 13 year old daughters to have their breasts removed though, not particularly to do with age or anything, just the fact that their daughters are more likely to be keeping it secret from their parents and risking broken ribs and a whole multitude of other health complications with binders and other home-made efforts to obtain and maintain the appearance of a flat chest.

As regards adults going abroad, off with them, they are old enough to go get themselves sterilised, castrated etc.

For sure, but the point being made was that taxpayers shouldn’t have to pay for it. If you’re aware of any circumstances in which simply by virtue of paying taxes, anyone has any authority whatsoever to insert themselves into decisions regarding any individual’s medical care, not just in relation to medical decisions about transgender healthcare, I’m all ears. It’d be setting quite the precedent were individuals by virtue of the fact that they pay taxes, entitled to impose their own moral standards on other people or in the provision of healthcare more generally! 🤔

Because it’s a news article, not a medical journal.

Not sure where you’re getting your information from that suggests Ireland is now following the Cass recommendations, nothing’s been decided or confirmed yet about the new model of transgender healthcare, still all very much up in the air with ongoing discussions with all stakeholders involved, including patient advocacy groups (like any other healthcare model really):

Campaign groups and activists, however, said there needed to be a “clear pathway” to support trans children and young people to receive gender-affirming care.

Karen Sugrue, the parent of a trans child and a founder of the Mammies for Trans Rights campaign group, said what was not working in the current system was the lack of help for trans children, who are then “DIYing” healthcare.

…

A Coalition of trans rights organisations, Trans Equality Together, called on the HSE to urgently implement a “person-centred model of care” based on the principles of self-determination and informed consent.

How Ireland provides transgender healthcare is set to be a hotly debated, and closely watched, topic in the coming years in the wake of the Cass report.

https://www.irishtimes.com/health/2024/04/29/what-now-for-transgender-healthcare-in-ireland-after-publication-of-the-cass-review/

People who are transgender and their families have considerably greater investment in the outcomes of any future policy decisions regarding the provision of healthcare services for people who are transgender, than the two medical professionals in the aforementioned RTE article.

Nah, the HSE didn’t refer any patients to Belgium, nor did the HSE engage in any private arrangements as is being suggested by Dr. Moran in that article, same doctor in the previous RTE article where it’s made clear the HSE has no involvement with the clinic in Belgium:

Unlike the Tavistock, the HSE does not formally refer patients to the Belgian clinic. It advised patients by letter about how to access care there. The Belgian clinic has treated fewer than five children from Ireland, according to the HSE.

…

In its statement, the HSE said it "became aware" that this clinic "was accepting patients" under its public health system. It said it "does not recommend the service. It simply informs patients of the availability of that public service".

It also said it has "no role in evaluating or otherwise approving a public healthcare service in another EU/EEA country".

https://www.rte.ie/news/primetime/2023/1214/1422073-leading-doctors-complain-hse-to-hiqa-over-transgender-care/

In years to come there won’t be any more medical malpractice lawsuits than there are already, not only because they are prohibitively expensive, but also because there’s no guarantee of a successful outcome. There are far more likely to be more lawsuits like this, still with no guarantee of a successful outcome:

https://www.bbc.com/news/articles/c6ppp6y5e9zo.amp

People who are transgender and their families have considerably greater investment in the outcomes of any future policy decisions regarding the provision of healthcare services for people who are transgender, than the two medical professionals in the aforementioned RTE article.

The same could be said of children with cancer. But you don't get those children or their families actively campaigning against the medics who are expert in the field.

From the RTE article:

"The patient should be supported in whatever decision that they make. It's kind of like supporting a child who wants to learn a language or an instrument," she said.

Under this model, according to Ms Ní Féineadh, the patient would decide on treatment even when the clinician is recommending against it.

What potential negative side-effects are there from learning an instrument? The comparison is downright dangerous. The state should be protecting children from this, not facilitating it blindly.

But what is trans healthcare. If you're a man I guess you have to keep taking drugs to suppress your natural testosterone, whilst taking copious amounts of estrogen to makes your newly acquired mammary glands grow bigger. A lifetime of taking drugs to make you less like your natural self, and more like a rough approximate of the opposite sex. The drug companies must love trans "healthcare".

It could, but the reason you don’t get children or their families actively campaigning against the medics who are expert in the field in those circumstances is partly because medics in the field aren’t trying to deprive their patients of a treatment, and partly because the medics don’t inform either the parents or the patients of the long-term effects and potential negative outcomes of the treatment. It’s often more than a decade later when patients have difficulty conceiving that they realise it’s linked back to the treatment they received for cancer in childhood:

Really? Cancer doctors don't inform either the parents or the patients of long term effects of medication? I highly doubt that. Most people know that cancer treatment can have severe side-effects. It would be very irresponsible not to point them out.

You’re stretching that benign analogy beyond its utility in order to take it completely out of context.

I most certainly am not taking it out of context. The fact it is comparing something quite benign, to something with potentially serious long term consequences is the whole point.

But since you ask the question, it’s rather like taking your benign suggestion to it’s extreme in pointing out the harm done to children by their parents who imagine their child is a genius, or a prodigy of some description, and forcing them to rehearse a musical instrument to the detriment of their personal and social development in other areas of a child’s early development, rendering the child ill-prepared as an adult to interact with others in wider society.

Bravo! That is genius! 😀

Well except that the analogy was referring to children who want to learn a language or an instrument, not ones being forced to.

It would, and it is, and I highly suspect that even when presented with evidence which contradicts your beliefs, you will continue to maintain your beliefs regardless:

Most (96%) parents valued information about late effects, and 93% considered late effects in their treatment decision-making. Yet, 24% could not recall receiving any information about late effects, and only 51% felt well prepared for potential late effects. Though only 20% of parents considered their child at high risk of experiencing late effects, 61% were extremely/very worried about late effects. Those who felt their child was at high risk of experiencing late effects were more likely to worry (OR=4.7, p=0.02).

That evidence doesn't contradict my beliefs. The closest you get to that is in bold above. Yet 76% recall receiving information and 24% are just not sure about it. But, we're talking about cancer now instead of gender dysphoria, so well done!

And yes, the analogy was intended to refer to children who want to transition - socially or medically, and to provide them with support, instead of denying them the opportunity to do so because you’re only concerned with the potentially serious long-term effects, and refusing to acknowledge the tangible serious long-term benefits of providing support for children who want to learn a language or an instrument or transition, instead of being forced to adhere to a particular course of action which you believe is in children’s best interests.

Whether I think there are long term benefits is not the point. Hillary Cass has just pointed out there's scant evidence of long term benefits. Treating one of a patient's many symptoms is not going to resolve all of their problems, especially if the symptom being treated is caused by another untreated condition. That would be an uncontroversial thing to say in any other branch of medicine.

Children’s autonomy is a contentious issue in any aspect of medicine, not just treatments for cancer or gender dysphoria. It’s the reason why opponents of the treatments persist in proffering and promoting all sorts of alternative theories that are unrelated to gender dysphoria by way of suggesting those issues should be examined to the exclusion of gender dysphoria. It’s not that they care about those issues not being addressed, it’s that they care first and foremost about maintaining their own beliefs by forcing children to maintain them in spite of the tangible evidence of long-term harm which children who are transgender experience as adults.

Cancer and gender dysphoria are not comparable in that regard. Far more cases of gender dysphoria will resolve themselves without treatment than cases of childhood cancer.

I'm not completely disagreeing with you by the way. If you were 100% wrong then there would be no need for a gender service for children at all. My point is we should leave it to the medical professionals to run it and the tough questioning that the patients are receiving is a good thing, not a bad thing.

@volchitsa That was a very interesting article (Tiger Reed), thanks for posting it. It was also very sad - I wonder how many people are in similar situations? Tiger / Roxanne did not say that she felt she had been born in the wrong body, but that, having had a very traumatic early life, she watched a TV program that seemed to offer "a way out of the pain of being a woman".

I also read the linked article by Jamie Reed - yet another case of the messenger being shot.

@plodder You rightly point out the flaws in the musical instrument analogy posed by Niamh Ní Féineadh. Most of her argument is disingenuous. For instance:

For adults to be referred for gender confirmation surgery in Ireland through the NGS, up to three further interviews can take place, she said.

"Those are very in-depth, and they talk in very specific and graphic detail about your sex life, what sex acts you enjoy, and how the surgery is going to impact those…That depth of conversation is unnecessary."

Well, with sex being such a fundamental part of adult life, if medical treatment is likely to have a negative impact on that then I think an in-depth discussion of outcomes and risks should take place. It doesn't need to be graphic, just fact based. Without such a conversation in advance of treatment, there is no possibility of informed consent.

"What other medical procedure do you have multiple in-depth interviews before you proceed with it? Do you have an in-depth interview with a clinical psychologist before you get an appendectomy?" she asked, describing as a "pathologising of transgender healthcare."

Again, a false analogy. There are well documented physical risks to appendectomy, however the mortality rate for acute appendicitis is 0.28% - 4% depending on where you are in the world, and gold standard treatment is appendectomy. Of course, you should be advised that the risk of death during the procedure is 0.08%. (I won't post links as this stuff is easily found). Presumably an operation going wrong could have long term effects, but this would be rare enough that it would be dealt with by counselling in the aftermath. Sending everyone to the psychiatrist/psychologist in advance of surgery would no doubt cause more harm overall in terms of unnecessary anxiety. You don't need counselling in advance of the removal of unhealthy tissue. Removing healthy tissue / organs is a whole other scenario though.

It is a bit ironic that she complains about the pathologising of transgender healthcare - what is surgically mutilating or giving drugs to physically healthy people if not a pathologisation of their condition?

And she further complains that the exploratory Model of Care supported by Dr Moran and Prof O’Shea can be invasive and stigmatising.

I wonder would that be more invasive than removing the healthy breasts or testicles of a teenager?

@One eyed Jack

Despite all your long posts, and linked documents, it is not clear what your position is on the specifics. You seem to be arguing in favour of the affirmative care model, but what do you think about the lifelong effects of cross-sex hormones or gender reassignment surgery (I don't like that term as it implies a medical impossibility, I think castration or mastectomy etc would be more useful)? Or the risk of sterility / sexual disfunction due to puberty blockers or other drugs? Or informed consent?

Well, with sex being such a fundamental part of adult life, if medical treatment is likely to have a negative impact on that then I think an in-depth discussion of outcomes and risks should take place. It doesn't need to be graphic, just fact based. Without such a conversation in advance of treatment, there is no possibility of informed consent.

There’s a flawed assumption underlying your argument there - that sex is such a fundamental part of adult life is based upon your own beliefs. It would be silly to extrapolate that out to the general population, let alone imagine that other individuals feel the same way about sex as you do. It isn’t a conversation that needs to be had at all is the point, because it’s irrelevant to the issue of the provision of transgender healthcare.

Again, a false analogy.

It’s not a false analogy, the point is there isn’t multiple in-depth discussions before an appendectomy is performed. There might be if the patient didn’t agree to certain procedures (such as refusing a blood transfusion should the procedure not go as expected), but that’s what is meant by informed consent - not what you’re thinking that a patient who refuses to discuss their sex life with the clinician vitiates informed consent. It does not.

It is a bit ironic that she complains about the pathologising of transgender healthcare - what is surgically mutilating or giving drugs to physically healthy people if not a pathologisation of their condition?

It’s not at all ironic - depathologising transgender healthcare is one of the reasons why the World Health Organisation declassified transgender health issues as mental and behavioural disorders -

Meanwhile, nine organisations working on gender identity said in a joint statement: "It has taken us a long time to get here. Until a few years ago, removing pathologising categories affecting trans and gender diverse people from the ICD-10 list of mental disorders seemed impossible. 

"Today, we know that full depathologisation can be achieved and will be achieved in our lifetime."

The statement added: "Although placement in this chapter is an improvement, it is by no means perfect. For example, it is somewhat reductive to define trans health as related only to sexual health.''

https://www.bbc.com/news/health-48448804.amp

Despite all your long posts, and linked documents, it is not clear what your position is on the specifics. You seem to be arguing in favour of the affirmative care model, but what do you think about the lifelong effects of cross-sex hormones or gender reassignment surgery (I don't like that term as it implies a medical impossibility, I think castration or mastectomy etc would be more useful)? Or the risk of sterility / sexual disfunction due to puberty blockers or other drugs? Or informed consent?

What difference would it make to you? If it were my child, you wouldn’t have any say in the matter, nor would a failed comedy writer, an author of children’s fiction, a former public defender who imagines the New York Education system is in decline, a psychologist who can’t tell what ‘meeting expectations’ means on her children’s school report cards, or a blogger whose opinions I genuinely couldn’t care less about. A paediatric doctor who is fully aware of the condition of the NHS, making recommendations about providing holistic healthcare and support services in local hubs in the UK probably wouldn’t be a go-to either, seeing as they’d have had to be fully aware of the fact that funding for existing hubs has already been cut to shìt by the same Government who appear to be more concerned about building regulations in relation to the provision of public bathrooms, than the provision of mental healthcare services in the UK:

https://www.gov.uk/government/news/government-to-lay-new-law-to-halt-the-march-of-gender-neutral-toilets-in-buildings

https://www.bps.org.uk/news/restore-investment-mental-health-support-nhs-and-social-care-staff-say-leading-organisations

Making recommendations that are doomed to failure would be an indication that real-world evidence was definitely, unquestionably, undoubtedly ignored in favour of upholding idealistic nonsense that would ensure the protection of shìt public services will continue until morale improves.

cancer and appendicitis can be tested for and measured fairly objectively using medical analyses like blood tests or scans etc, while it is impossible for a healthcare professional to measure someone's level of gender dysphoria other than by what they say.

A diagnosis of gender dysphoria too has objective criteria which must be met in order to diagnose a patient with gender dysphoria. And it can be measured objectively, meaningfully and accurately indeed by what a patient says, and indeed what they’re not saying. That’s where a clinician relies on their training, knowledge, experience and expertise in order to form a professional opinion on whether a patient meets the criteria for gender dysphoria, and if they do, what are the next recommended steps involved in treating the condition.

That’s why Cass was writing a letter to the NHS informing them about clinicians having difficulty with patients having unrealistic expectations - if those patients didn’t voice their concerns and expectations, that would definitely make a clinicians job that much easier as they could simply default to what they know and apply the same assumptions to all their patients, like imagining that for them because sex is such a fundamental part of adult life, it must be the same for everyone.

‘Twould be a poor clinician would operate on that assumption, but I’ve heard of, and personally experienced much worse poorly thought out assumptions. Thankfully it was often rectified quickly when they removed themselves from the team thinking that they couldn’t easily be replaced and they’d be missed 🙄 Other times the patient simply sought treatment elsewhere rather than returning to that particular clinician or therapist.

The objective test exists in the diagnostic guidelines, same as any other condition, whether it’s cancer or anything else. You hardly need to be provided with evidence of the failure of clinical diagnostic testing procedures in testing for cancer and misdiagnoses, given recent events in that regard? The objective tests which you’re referring to are not infallible either.

Satisfaction as defined by whose standards? Yours, or the consensus among clinicians involved in the diagnosis and treatment of gender dysphoria (or gender incongruence as it’s now defined)? The point you’re ignoring or downplaying or dismissing of course is that the patient isn’t healthy, they have a diagnosis of a medical condition, one that in the most extreme circumstances requires extreme treatment. They are not decisions which are taken lightly any more than blasting a child with radiation which is almost guaranteed to render them sterile, in order to treat cancer, is a decision that is taken lightly.

Undoubtedly there is ongoing research in order to improve treatments and clinical practice in order to reduce the risk of adverse outcomes and unintended, unforeseen side-effects which may present in later life depending upon the patient’s choices in later life as to whether or not they wish to start a family for example. That’s why clinicians aim to preserve fertility, so that even if patients don’t wish to even consider the possibility of starting a family in their current circumstances, they may wish to do so at some point in the future, and that option is there for them at that time, more likely through AHR if they wish to have a biological connection to their offspring, than traditional home-methods like the turkey baster method.

I was already at peace with infertility in exchange for any kind of future living as my true self. Transitioning would, I thought, mean losing the ability to conceive. The consent form for starting T made the apparent trade-off clear but I signed it without hesitation, having contemplated what this would mean for years. Plus, the tone of the consultant’s advice seemed clear: 

If you’re really a man, you won’t care much about having kids. In fact, you probably just want to whip that womb out asap, eh?

…

Coincidentally, in 2016 I learned that testosterone probably hadn’t made me infertile after all. I discovered this by chance from a YouTube vlog. In the almost eight years since, I’ve carried and given birth to my two children via artificial insemination and donor sperm. I’ve also, perhaps unsurprisingly, become interested in the research around trans people’s fertility and our reproductive choices. Needless to say, there’s very little research of this kind, including zero empirical evidence that testosterone affects trans male fertility. I still don’t know why doctors tell us it does, but I’m fairly sure that it’s got nothing to do with science.

…

Thankfully, I learned my truth before it was too late. If I’d followed the standard NHS pathway and had a hysterectomy, believing testosterone had made me infertile and that the procedure was necessary to prevent certain cancers (a claim that is now debunked), my kids would not be here today. Having been through this, it pains me to think of women seeing frozen eggs as an investment in their future, only to discover, once they’re already out of other options, that it’s nowhere near as simple as that.

In both contexts – in all contexts – healthcare providers have an absolute duty to provide accurate and unbiased information. Nothing should be allowed to blur those lines, be it profit margins or a misplaced desire to police social and gender norms. Women and trans people of all kinds know equally well what it is like to be misled, ignored and undermined by doctors. Sometimes our experiences are very similar and sometimes very different. In either case, there are insights to be learned and shared.

When it comes to reproductive health and choice, we all need better, more ethical and more affordable person-centred care and we are all much more likely to get it if we work together.

https://amp.theguardian.com/commentisfree/2024/mar/16/women-egg-freezing-doctors-transition-healthcare-trans-gender

That’s written by someone who has been through the process, and given birth, twice:

McConnell announced his second pregnancy in August 2021, with plans to give birth in Sweden in order to be listed as the child's father, rather than mother, on their birth certificate. His second child was born in the UK in January 2022 via emergency c-section.

https://en.m.wikipedia.org/wiki/Freddy_McConnell