The fact that the consensus differs so heavily between countries where this topic has become a political issue, and countries where it’s not yet become one (e.g., Germany), leads me to suspect these sources are biased.

This applies especially to british sources on this topic. The NHS and BBC have become heavily influenced by the Tories in recent years, so I’ll have to question your sources.

Anti-trans campaigners misunderstand what's meant by "low quality evidence". It just means we don't yet have double blind randomised control trials of certain treatments. But that's to be expected: trans children are rare, we don't put anyone on puberty blockers without very good reason, and withholding PBs is not a neutral act. So running RCTs on this population group is very difficult.

See also masks: we're pretty sure that masks work, but the evidence for masking is low quality.

Anti-trans campaigners also misrepresent the Cass review. The review has said that taivstock (currently the only provider of specialist care to trans children) isn't very good. (Trans children and their families also say that the tavistock is pretty awful). They then say that this proves the anti-trans argument that no gender affirming care should be provided to trans children. But what Cass has said is that care should be taken out of tavistock and new given to new centres across England who will initiate care and then GPs can be allowed to continue that care -- this is a big expansion of gender affirming care for children, and trans people welcome it. It's what people have been asking for for years.

Cass does have some weird anti-trans aspects, but it's certainly not the win that anti-trans campaigners are claiming. And this is a core feature of UK anti-trans campaigning: they're fundamentally dishonest about everything all the time. You should always read the sources they're citing, because they always misrepresent those sources.

> Anti-trans campaigners misunderstand what's meant by "low quality evidence". It just means we don't yet have double blind randomised control trials of certain treatments.

No it doesn’t. The problems run far deeper. Read the interim report, pages 18-19[1]:

> 1.24. A lack of a conceptual agreement about the meaning of gender dysphoria hampers research, as well as NHS clinical service provision.

> 1.25. There has not been routine and consistent data collection within GIDS, which means it is not possible to accurately track the outcomes and pathways that children and young people take through the service.

> 1.26. Internationally as well as nationally, longer-term follow-up data on children and young people who have been seen by gender identity services is limited, including for those who have received physical interventions; who were transferred to adult services and/or accessed private services; or who desisted, experienced regret or detransitioned.

> 1.27. There has been research on the short-term mental health outcomes and physical side effects of puberty blockers for this cohort, but very limited research on the sexual, cognitive or broader developmental outcomes.

This is not about a lack of rigorously designed experiments. This is about very basic gaps in definitions, data collection, and followup. This is not a case of “we did some research and it’s basically fine but the science police won’t acknowledge the result because we didn’t fill the form out correctly”. We fundamentally do not have the evidence.

Additionally, the new UK regional centers are not an expansion of gender-affirming care, they are an expansion of care, period. The presumption of gender affirmation was explicitly criticized, and in the forthcoming service model there is a requirement to deal with the whole clinical presentation.

None of this has any bearing on being “pro-trans” or “anti-trans”. It is about uplifting treatment for gender dysphoria to the same standards of evidence-based medicine that we expect for any other clinical issue.

I agree, sources are frequently misrepresented.

[1] https://cass.independent-review.uk/wp-content/uploads/2022/0...

> No it doesn’t

Yes it does. You not knowing what GRADE is or how it works but insisting that you are well informed is a great example of the problem with these discussions. You dump a load of ill-informed mangled sources into a thread, and now I have to spend a few hours explaining how you're misrepresenting the sources.

> Additionally, the new UK regional centers are not an expansion of gender-affirming care, they are an expansion of care, period. The presumption of gender affirmation was explicitly criticized, and in the forthcoming service model there is a requirement to deal with the whole clinical presentation.

I've read the service specification for the new centres. (Have you?) It's an expansion of gender affirming care, and there's no way to spin it otherwise. There will be more clinics treating more children in a more timely way. More children will have access to puberty blockers. What's that if it's not an expansion of service?

> None of this has any bearing on being “pro-trans” or “anti-trans”.

All the information you've posted to this thread so far is sourced to anti-trans organisations. At least be honest about it. You are anti-trans, you post anti-trans disinformation from anti-trans links.

I mean, you're making the same three claims as if they're magic gotchas but you don't understand what you're saying.

1) Care at tavistock is bad

Yes, everyone agrees, that's why people are pleased that Cass recommends the NHS continues its long established plan to remove care from Tavi.

2) There's no evidence

There's plenty of evidence. It doesn't come from tavi, but that's because they provide so little care it's not possible to use their patients as experimental subjects. We have lots of evidence from other countries and other patient cohorts

3) Cass says...

Mostly you're misunderstanding what Cass says, or you're relying on the single source that agrees with you and ignoring international scientific and medical opinion.

4) The new centres are providing less gender affirming care than tavi

The vast majority of children attending tavi got no care at all because they were on a waiting list and then aged out of children's services. But even if they got treatment at tavi the vast majority got no meds at all but psycho-social advice. The new centres will be doing this too, but with more children and with smaller waiting lists and the shared care agreements with GPs will be clearer.

I keep mentioning Cass because it is a breath of fresh air in this bitterly polarised subject area, compared to news sources. It is level-headed and compassionate, and I encourage you to try reading it, if you can excuse its Britishness.

I've read it, but its arguments are still at odds with what's done based on it.

e.g., the Cass Review explicitly says "The rationale for use of puberty blockers at Tanner Stage 2 of development was based on data that demonstrated that children, particularly birth-registered boys who had early gender incongruence, were unlikely to desist once they reached early puberty" and only recommends reviewing puberty blockers for AFAB people.

Yet your comments and british politics instead call for ending the use of puberty blockers for everyone, including AMAB people (and the recent tavistock case actually accomplished that).

Most of the other issues the report finds are entirely local to the UK, due to the way healthcare systems differ heavily between countries, and can't be applied elsewhere.

I'll be entirely honest, the british system is an absolute mess and needs to be entirely rebuilt (and any british trans person is going to agree), but just stopping all care entirely for years until a new system exists is the worst possible option, and one that's going to cost countless lives.

This is untrue. Puberty blockers have been in use for trans children for over 40 years now, we have lots of evidence of benefit and lots of evidence that there's not much harm.

We don't have randomised controlled trials, but if you don't know why we don't have those maybe you should refrain from commenting until you understand the topic a bit more.

What about detransitioners? Most of those kids grew into adults that have been ruined for life. Knowing this, the risk of giving these drugs to kids to outright block their puberty is just too immense. Not to mention the underage surgeries some of them receive.

> What about detransitioners?

Detransitioners are a tragic case, but they amount of detransitioners compared to all trans people is smaller than the amount of trans people compared to the rest of the population.

If taking detransitioners into account is the primary priority of trans healthcare for you, then trans people should be an equal or larger priority in overall healthcare as well.

> Not to mention the underage surgeries some of them receive.

That's something that's questionable, but it's not that simple either. Cis people doing surgery against gynecomastia is the majority of underage surgeries of this type.

> to outright block their puberty

It's just paused. It continues as if nothing had happened the moment you stop, with no risk to the patient. Even the Cass Review argues that blockers are entirely safe for AMAB trans people. It also argues that AMAB trans people have such a small percentage of detransitioners that it's basically disregardable.

If the Cass Review, a paper that was commissioned to find a way to reject healthcare for trans people, argues it's safe, you can trust it is safe.

> Even the Cass Review argues that blockers are entirely safe for AMAB trans people. It also argues that AMAB trans people have such a small percentage of detransitioners that it's basically disregardable.

I've read the Interim Report, it asserts neither of these points.

the Cass Review explicitly says "The rationale for use of puberty blockers at Tanner Stage 2 of development was based on data that demonstrated that children, particularly birth-registered boys who had early gender incongruence, were unlikely to desist once they reached early puberty" and only recommends reviewing puberty blockers for AFAB people.

Your quote misses out the part of the sentence immediately following:

"this rationale does not necessarily apply to later-presenting young people, including the predominant referral group of birth-registered girls"

The group referred to here is defined by being later-presenting. Female is only a subset of this.

Also, Cass is just describing the rationale, not endorsing it. This is implied by the paragraph immediately following, where she discusses the paucity of data regarding potential negative effects of puberty blockers on brain maturation:

"A further concern is that adolescent sex hormone surges may trigger the opening of a critical period for experience-dependent rewiring of neural circuits underlying executive function (i.e. maturation of the part of the brain concerned with planning, decision making and judgement). If this is the case, brain maturation may be temporarily or permanently disrupted by puberty blockers, which could have significant impact on the ability to make complex risk-laden decisions, as well as possible longer-term neuropsychological consequences. To date, there has been very limited research on the short-, medium- or longer-term impact of puberty-blockers on neurocognitive development."

> and only recommends reviewing puberty blockers for AFAB people

Cass does not make this recommendation.