World Professional Association for Transgender Health (WPATH) Files

AllForIt

Not sure if this is as a result of the wpath files as I can't read the whole thing. Anyone got a sub? archive.ph is down.

https://www.independent.ie/irish-news/hse-will-not-require-new-transgender-health-plan-to-follow-international-wpath-guidelines/a670015272.html

volchitsa

https://www.boards.ie/discussion/comment/121874481#Comment_121874481

archive.is works for me: https://archive.is/9fEKD

CatFromHue

https://www.boards.ie/discussion/comment/121874226#Comment_121874226

The growth in referrals was one factor but the method of care was another. It's not down to underfunding that Cass has issues with the method of care, it's down to the evidence base.

I 100% do want these kids to get the best help for their needs and that help should be evidence based.

Shoog

https://www.boards.ie/discussion/comment/121874670#Comment_121874670

So if the evidence points to harm reduction through hormone therapy and surgery then you would be absolutely fine with that ?

Because the evidence is clear that those who transition have far better outcomes than those who don't (survival rates and reduced need for mental health services been the metric here).

volchitsa

https://www.boards.ie/discussion/comment/121874693#Comment_121874693

Evidence for this astonishing claim please? Because that was the WPATH view but as more studies have been done, that has been shown not to be the case. Even GIDS at the Tavistock couldn't make their long term study produce that much wanted evidence, which seems to be why they delayed publishing it for so long.

https://www.bbc.com/news/uk-55282113

That's also why several countries like Finland, the Netherlands and Sweden (the most "progressive" countries, and the earliest adopters of the affirmative approach) are now rowing back on the PB pathway treatment.

https://www.france24.com/en/live-news/20230208-sweden-puts-brakes-on-treatments-for-trans-minors

https://www.theatlantic.com/health/archive/2023/04/gender-affirming-care-debate-europe-dutch-protocol/673890/

Edit - wrong thread!

CatFromHue

https://www.boards.ie/discussion/comment/121874693#Comment_121874693

If you have high quality evidence for this then yes, I would accept it. You do need the high quality evidence for this level of intervention though and that's just not there.

The DSM, which is backed up by strong evidence, states that for the majority of children and adolescents going through gender distress it will not persist into adulthood. That means there is a minority, which I think is actually a small minority, it doesn't and they're what we call transgender. For that group hormones and other interventions might be the best way to go. Donal O'Shea, who is strongly against the WPATH's standards of care, has said that one of his most satisfying patients was an adult person who transitioned. This was an adult not a child or adolescent.

The problem with the paediatric clinics is that no one, including the Dutch who first started prescribing blockers, knows who will or won't persist into adulthood. They all present to the clinic the same. Under the WPATH's model there is a very strong danger that patients who left alone would work themselves through the dysphoria, and most would realise their sexuality, are now being medicalised. So you need a controlled trial, which is usually the method to evaluate the affect of a drug on a population, but there's never been one. The Dutch protocol that blockers are based on never did one and they also excluded most of the people that are now presenting to gender clinics. If you had other mental issues, a history of trauma, they didn't let you on their study and you also had to have gender distress for a young age and come for a supporting family. They effectively guessed who had the strongest gender identity, but it was just a guess.

That's before you start to talk about the massive change in demographics of the patients presenting to gender clinics. Previously it was mainly boys, not all, who had gender distress from a young age. Now it's mainly girls who only start to go through gender distress as teenagers. So the already weak evidence base is not applicable to this group.

There is a very good reason why Cass says

"A lack of consensus about the appropriate clinical response......

the clinical approach and overall service design has not been subjected to some of the normal quality controls that are typically applied when new or innovative treatments are introduced......

At this stage the Review is not able to provide advice on the use of hormone treatments due to gaps in the evidence base"

The evidence base for this level of intervention, the way the WPATH has set out in their standards of care, just isn't there. It may be in the future but it's not there are the moment.

The outcomes for those who transition as children or adolescents is still mostly unknown. There are studies that say the outcomes you say but they're low quality and there's also studies that disagree with the outcomes you say.

Just as an FYI RTE Primetime did an episode on this area few weeks back.

Leading doctors report HSE to HIQA over transgender care | Prime Time (youtube.com)

Shoog

When around 13% of all referrals go into receive any drug or surgical treatments I think that the checks are working very well as is. As such I do not buy into the whole fast track to puberty blockers hysteria driving the transphobic narrative.

The services are largely working and helping the majority of their patients. That more research is been carried out can only be a good thing which I think trans support bodies welcome.

I absolutely think that a small number of pre-teens who show acute gender distress are correctly prescribed puberty blocks, and the assessment process works to identify these vulnerable children. The fact that so few referrals end in active treatment is testimony to the care offered in assessment of children.

The attack on transgender services is a culture war issue and really most of the people in outrage have very little genuine concern for the welfare of individual children presenting with gender distress. It's just another wedge issue which works so well for galvanising the rights support base. It was exactly the same with gay rights up until it was an unsustainable position to take in public.

Overheal

https://www.boards.ie/discussion/comment/121873821#Comment_121873821

Ad hominems. Typical

https://www.boards.ie/discussion/comment/121875258#Comment_121875258

Do you buy into the fast-track to puberty blockers, though, leaving out the term hysteria?

CatFromHue

https://www.boards.ie/discussion/comment/121875258#Comment_121875258

I don't know where the 13% came from but some of the clinicians who worked in the Tavistock said they felt they were moving too quickly to medicalisation. When some of the Irish patients who were seen by the Tavistock then moved to the adult service and were seen by the NGS here there was a lot of concern at the lack of care for these patients.

If you think saying that the WPATH's methods are not fit for service when any country or health body that has done an independent review has reached that conclusion is some sort of attack on trans people, then it's you who I would be asking do you have any concern for these kids?

When you start medicating people there is an evidence base that is required to do so. Without that it's gay and autistic kids who will lose out as the WPATH's guidelines are a form of conversion therapy.

One eyed Jack

https://www.boards.ie/discussion/comment/121875905#Comment_121875905

If you think saying that the WPATH's methods are not fit for service when any country or health body that has done an independent review has reached that conclusion is some sort of attack on trans people, then it's you who I would be asking do you have any concern for these kids? 

But no country has come to that conclusion? They wouldn’t in any case because the WPATH guidelines are just that - guidelines, in best practice in transgender, gender non-conforming and non-binary healthcare.

They’re pretty much informed from a US-centric perspective, much like the DSM, whereas in Europe and the rest of the West, clinical professionals in psychology and psychiatric medicine would place more emphasis on the standards provided by the ICD-11 (WHO regard themselves as the world authority! 🤔). The WPATH guidelines are on their 8th edition, being under review and revision since the late 70’s, the DSM is on it’s 5th edition, and the ICD… well, you get the idea - these guidelines and standards are under constant review and scrutiny and you could pretty easily point out the fundamental flaws in each of them depending upon your own particular perspective.

That’s because they’re not just based on evidence provided by medical science, they’re also informed by the social and political sciences which manifest in the context of the countries in which the question of best practices in transgender healthcare arises. Ireland is having to deal with this reality in the same manner as other countries are dealing with it. Not as you suggest though -

https://www.politico.com/news/2023/10/06/us-europe-transgender-care-00119106

And if you’re not looking too hard, you might just have missed where Government says one thing, HSE says another, and the person appointed to the position of the new clinical lead for transgender services provided by the HSE… says something entirely different again 😳

https://www.thejournal.ie/transgender-clinic-ireland-6252837-Dec2023

When you start medicating people there is an evidence base that is required to do so. Without that it's gay and autistic kids who will lose out as the WPATH's guidelines are a form of conversion therapy.

That nonsense has been debunked more times than I change my underwear… ok that’s not saying much, but basically it’s been debunked, a lot. Not the part about when you start medicating people there is an evidence base that is required to do so (in many areas of medicine there are unique challenges for which there is no previous evidence or body of knowledge that clinicians can reliably identify a predictable course of action or treatment), I get that much, I figure you mean in traditionally practiced medicine that there isn’t the same sort of political wrangling involved. Like a broken leg is a broken leg, standard stuff, whereas anything to do with something which has a greater influence on society such as whether or not homosexuality is considered a mental disorder under previous revisions of the DSM and ICD?

One doesn’t need to be particularly bright to understand why some people who are opposed to a particular concept gaining any traction in society would be more in favour of the “wait and see” approach, or throw everything bar the kitchen sink at it like autism, homosexuality and/or bipolar disorder, previously known as manic depression in the hope that these can be conflated, rather than recognised as existing independently in individuals experiencing distress and whether that distress is caused by gender incongruence, or the way they are perceived in society because of the fact that society is structured around recognition, acceptance and protection from discrimination of people based on the binary status grounds of sex or gender - male or female, masculine or feminine, etc, and human beings who don’t fit into that paradigm or frame of reference?

They are not worthy of equal recognition or respect as human beings entitled to the same rights and protections and responsibilities as members of any given society. Unfortunately, there really is no common ground between the medical and social models of transgender healthcare, and that’s why whereas previously people who are transgender, if they sought treatment, one of the conditions of being offered treatment was mandatory sterilisation. Sweden was notorious for it, as well as practically every other European country and indeed the US.

There was nothing said about depriving people of their fertility then, yet when it’s taken off the table because it was considered a violation of human rights standards… NOW some people are getting animated about any potential loss of fertility? Less of a concern with recent developments in fertility and the provision of transgender healthcare (that’s where your evidence based medicine comes in), and that’s what they’re hoping to hang their hat on in terms of attempting to prevent people from having access to healthcare which they find unethical? You’d have to wonder have those people any idea of the history of science and medicine? This is a good primer if they’re interested in the background to the current culture wars, which have nothing to do with medicine and science -

https://sciencebasedmedicine.org/cutting-through-the-lies-and-misinterpretations-about-the-updated-standards-of-care-for-the-health-of-transgender-and-gender-diverse-people/

Shoog

https://www.boards.ie/discussion/comment/121875577#Comment_121875577

I do not think there is such a thing as fast track puberty blockers. Blockers are only prescribed at puberty after extensive consultation with the patient and parents. No doctor in Ireland is pushing them on children.

volchitsa

https://www.boards.ie/discussion/comment/121878350#Comment_121878350

Doctors are not - in fact several Irish doctors have expressed severe concerns with how the HSE followed GIDS blindly. They were vilified for that. They've also pointed out how activists are coaching children to "say the right things" so that it's hard for therapists to refuse drugs, not because the child really has the profile, but because they learn how to sound like they do.

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

The problem being that WPATH is a US based group (despite renaming itself "World") run by activists rather than objective researchers. And groups like spunout.ie and others that have been quoted as sources earlier are also activists rather than neutral.

Podge_irl

https://www.boards.ie/discussion/comment/121875258#Comment_121875258

This is just base rate fallacy writ large. If only 5% of referrals or as many as 25% of referrals needed treatment then the checks would clearly be working terribly.

This all flows back to the completely I sufficient evidence base for a lot of treatment protocols. Which is why many bodies are pulling back from the guidelines but importantly _also pushing for studies_ to be done. Something that would ordinarily be completely controversial and normal practice.

More treatment and more easily accessible treatment are great things. Fully support them. But it's vitally important it is the correct, properly evidenced treatment.

plodder

https://www.boards.ie/discussion/comment/121873291#Comment_121873291

At the same time, the doctors in the National Gender Service have been at loggerheads for years with non medically qualified activists, and bizarrely up to now, it looks like the HSE has taken the activists side. How ridiculous is that?

CatFromHue

https://www.boards.ie/discussion/comment/121876961#Comment_121876961

"NHS England has made it clear that WPATH’s views are irrelevant to its core recommendation that puberty blockers will no longer be available as part of routine clinical practice."

Why disturbing leaks from US gender group WPATH ring alarm bells in the NHS | Hannah Barnes | The Guardian

CatFromHue

https://www.boards.ie/discussion/comment/121878350#Comment_121878350

In Ireland no, but they are a core part of WPATH's treatment model.

Shoog

https://www.boards.ie/discussion/comment/121880818#Comment_121880818

That doesn't change what I said, puberty blockers are used when puberty sets in for that small proportion of adolescents who are highly likely to transition in the estimating of their expert medical team. As I have said before puberty blockers are an appropriate treatment for certain individuals when they reach the onset of puberty. I have few doubts about the validity of the recommendations regarding them.

One eyed Jack

https://www.boards.ie/discussion/comment/121880815#Comment_121880815

Did you just not see the previous line in the article?

It is difficult to see how the Department of Health’s assertion that NHS England “moved away from WPATH guidelines more than five years ago” holds.

What is true is that there is no mention of WPATH in updated guidance that will underpin the new youth gender services opening on 1 April. What’s more, NHS England has made it clear that WPATH’s views are irrelevant to its core recommendation that puberty blockers will no longer be available as part of routine clinical practice.

It’s not difficult to see how the Department of Health’s assertion that NHS England moved away from WPATH guidelines more than five years ago holds, unless one is keen to make the implication that it’s only NOW that the NHS considers the WPATH guidelines irrelevant. They haven’t been considered relevant by the NHS for the last five years, thereby it would have been impossible to conclude they were not fit for purpose, when they weren’t even considered in the first place in the formation of any policies relating to PSH for children and adolescents who have gender incongruence/dysphoria:

The policy proposition has been developed following a peer review of peer reviewed published evidence as per NHS England Policy Development Methods. NHS England does not commission based upon guidelines or treatment protocols eg WPATH 8.0 or practices in other countries.

The not for routine commissioning position has been concluded based on insufficient clinical benefit to the patient of which evidence of harm is one aspect.

NHS England has now established a new national Children and Young People’s Gender Dysphoria Research Oversight Board. The Oversight Board has approved the development of a study into the impact of PSH on gender dysphoria in children and young people in addition to planned further engagement to identify the key evidence gaps for children and young people with later-onset gender dysphoria.

https://www.engage.england.nhs.uk/consultation/puberty-suppressing-hormones/user_uploads/engagement-report-interim-policy-on-puberty-suppressing-hormones-for-gender-incongruence-or-dysphoria.pdf

Of course it’s easy to see why the author of the article would be keen to make that implication given she wrote a book with a title which has no hint of irony whatsoever:

Hannah Barnes is associate editor at the New Statesman and author of Time to Think: The Inside Story of the Collapse of the Tavistock’s Gender Service for Children

There wasn’t much thought put into the article either.

Shield

From Spotlight:

They knew. And they let it happen. To kids.

Annasopra

https://www.boards.ie/discussion/comment/121875214#Comment_121875214

The emerging evidence though is that very few trans adolescents detransition. This study from Australia shows only 1%

ceadaoin.

How long is the follow up on that study? It's hard to desist when you've already changed your pronouns and name, let alone been put on puberty blockers and maybe even cross sex hormones and possibly had surgery. Before these "treatments" were standard practice, the overwhelming majority of "trans" adolescents did desist, and were perfectly happy, usually gay, adults happy in their own bodies. Every single study showed this, why the need for new "emerging" ones? If you're happy with a new form of conversion therapy then good for you I guess, but the children subjected to it won't thank you in the years to come.

volchitsa

https://www.boards.ie/discussion/comment/121882064#Comment_121882064

I can't see any study there, but detransitioning is only one measure of failure, and the most drastic: I don't know if there are studies on this but there's plenty of anecdotal evidence from that many young people who've transitioned don't "retransition" mainly because they feel it's impossible, because they can never get back to what they would have been before hormones and surgery. That's more often the case for women because testosterone causes irreversible changes, particularly on the voice, but genital surgery is impossible to fully reverse for both sexes.

So it's highly likely that one reason why people don't retransition is a feeling that regrets are pointless, and it's better to try to make it a success, even when it clearly isn't.

A much better measure of success would be whether suicide rates and general mental well being are improved - and recent studies show that they aren't. Previous studies that supposedly did show that all have massive design flaws, or do not apply to the current profile of transitioners.

crusd

There are two things here.

A legitimate debate on the appropriateness of certain treatments for underage children with expressed trans ideation, which is legitimate, but limited to a tiny numvber of cases

And the blatant attempts to conflate any expressed empathy with trans identified individuals as automatically supporting the forced medication of children and ultimately the use of such as a wedge issue to conflate any "liberal" views as being supportive of forced medication of children.

volchitsa

https://www.boards.ie/discussion/comment/121882437#Comment_121882437

The problem is that "No Debate" tactics, where any discussion at all is denounced as "You want trans people to die" is all the doing of the TRA side. The exact opposite of the way you're presenting it.

Doctor Jimbob

I can't think of any other topic that has attracted such a disproportionate amount of attention and rage as trans people. They're a tiny minority that in my experience just want to be left alone to live their lives - yes, some tend to be vocal about it, but I'd probably be quite vocal too if I had to listen to people bang on about how I'm the downfall of society every 5 minutes.

Leave them the feck alone and worry about an actual problem.

chopperbyrne

Putting confused children on an irreversible medical pathway is an actual problem.

volchitsa

https://www.boards.ie/discussion/comment/121882565#Comment_121882565

Interestingly male-centred view of the world that ignores completely that 51% of the population are adversely affected by allowing entitled males to pick and choose the parts of womanhood that they want to have, especially access to spaces where, for the protection of women, men are usually not allowed to be. So it does not concern a tiny minority of the population - but women are apparently a part of the population whose needs and interests are entirely invisible to you. You can only see the males, including the transgender ones.

And on the aspects of this issue that are relevant to this thread, if anyone is being given inappropriate and possibly dangerous treatment based on poor evidence, then it doesn't matter how few of them there are, it should be a major concern to all of us. Not that many children were damaged by thalidomide, overall - but it was still a major scandal.

One eyed Jack

https://www.boards.ie/discussion/comment/121882107#Comment_121882107

Are you sure that’s the argument you want to be making? Because that would suggest that the standard practice treatments intended to alleviate gender dysphoria are effective in long term studies? Sexual orientation for example has nothing to do with gender identity, so the idea that patient outcomes involving standard practice treatments lead to happy gay adults isn’t saying much, let alone that it has any negative outcomes for the patients involved. If I were trying to argue against standard practice treatments, that’s not the argument I’d be making.

As to the studies themselves, well, frankly they’re all over the place, for numerous reasons, and there’s very little studies done in this particular area compared to studies done in other areas, and like all treatments, the reason there needs to be constant and evolving research is to devise better treatments, and in all likelihood there are bound to be positive and negative effects and outcomes of any treatment. For example it’s only recently that scientists have been able to study the effects of standard treatments for long-term patients given most of them didn’t live that long previously, and it turns out that long-term patients are at higher risk of developing cardiovascular disease than among the general population. Upon reading it however, you’ll immediately notice that while the study was conducted over a long period of time, the number of participants involved was too small to determine anything conclusive - more research is required to either confirm or reject the findings of this particular study:

https://www.news-medical.net/news/20231006/New-research-sheds-light-on-metabolic-problems-faced-by-transgender-people.aspx

That study doesn’t reflect the patients happiness levels or sexual orientation though, and neither does this one, done over a period of 30 years on a patient cohort who received surgical interventions over a period of 10 years. Their biggest problem (the researchers that is, not the patients), is that they couldn’t find enough patients who were unhappy with the outcomes, in order to perform a proper clinical analysis:

https://pubmed.ncbi.nlm.nih.gov/37556147/#:~:text=Importance%3A%20There%20has%20been%20increasing,heavily%20on%20ad%20hoc%20instruments.

If you regard current practices as a form of conversion therapy, then either you’re not familiar with conversion therapy (seems unlikely), you’re not familiar with current practice (seems just as unlikely), or you’re using the term ‘conversion therapy’ as an emotional argument knowing full well people’s aversion to conversion therapy. Those opposed to current practices, prefer the term ‘gender exploratory therapy’, like that’s not conversion therapy… oh wait, that’s exactly what it is:

https://en.m.wikipedia.org/wiki/Conversion_therapy#Gender_exploratory_therapy

And without meaning to state the obvious - no, I wouldn’t be happy if that form of therapy’ were ever to be taken seriously by clinicians. I wouldn’t recommend those clinicians who do promote ‘gender exploratory therapy’ be let within a mile of any child. Unfortunately the internet allows them to propagate their narrative where parents desperately seeking help for their children will agree to pretty much anything in order to see their children grow up into happy gay adults, they can pray the gay away later and then they’ll be happy straight adults, like this guy:

https://www.nbcnews.com/news/amp/ncna961766

Ehh, ok maybe not him.

There is a serious side to that story of course given the thousands of people who were harmed and continue to be harmed by his actions, but that’s another story, suffice to say he has no regrets either.

But the idea that people should be thankful for the actions of others is predicated upon the idea that people expect thanks, or expect that other people should be grateful when they are treated with the most basic standards of human dignity and respect. That’s one idea I could never get my head around, but if I may by way of demonstrating what I mean:

I expected when he was born that my son would hate me by the time he was a teenager, that the teenage years are the hardest and all the rest of it, I’ve no doubt you heard the same from other people, seems unlikely you’d ever heard from anyone that you’d make a terrible father, cos, y’know… obviously! 😂

Basically everything was pointing towards a foreboding outcome, and for me I didn’t care that my son wouldn’t be grateful or thankful or kissing my arse or any of the rest of it, hate that shìt, feigned respect out of a sense of fear or intimidation or insecurity, but as it turned out, he doesn’t hate me at all, and we have a very good relationship, and I’m kinda left wondering - where did I go wrong? 🤔

There’s good reason for every country developing their own standards as opposed to following the WPATH guidelines, and that is that the guidelines themselves are based on an idealised standard as opposed to a realistic standard, an idealistic standard is beyond the capacity of most countries Governments and national healthcare systems are able to provide for. That’s why they’re often failing miserably, not just in terms of providing healthcare for people who are transgender, but in all aspects of public healthcare. Our own healthcare system is no exception. Best practice means just that, it doesn’t mean that the same treatment is going to work for every patient in all circumstances. That kind of thinking is what leads to this sort of outcome -

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