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World Professional Association for Transgender Health (WPATH) Files

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Comments

  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    I think considerable harm will be done by withholding puberty blockers from those very small percentage of children who they are considered appropriate for, but the good thing is that as a consequence of the Cass recommendation my opinion will have a much stronger evidence base in the future - which can only be considered a good thing.

    And I genuinely do not believe for one second that if I am confirmed in this position that you would change your opinion one inch and support their use.

    Post edited by Boards.ie: Mike on


  • Registered Users, Registered Users 2 Posts: 10,373 ✭✭✭✭Birneybau






  • My opinion is irrelevant. I neither support nor don't support puberty blockers. In the same way I neither support nor don't support a particular drug.

    It's not my decision to make. It's the clinician's decision.

    And as long as that decision is evidenced-based medicine, that's what matters — not what I personally like or dislike.



  • Registered Users, Registered Users 2 Posts: 8,784 ✭✭✭volchitsa


    Except the ones who had to leave the field because they were vilified for expressing safeguarding concerns, right?

    Not those clinical experts?

    People like Sue Evans, way back in 2004, or Sonia Appleby, whose actual job was child safeguarding.

    Or Dr Marcus Evans, or Dr Kirsty Entwhistle. Plus all those who went to Dr David Bell anonymously because they knew what would happen to them if they spoke out openly.

    All people who chose to work with young people with gender dysphoria but ended up feeling that GIDS was not interested in safeguarding because it was too influenced by activists over clinical evidence - but you'd say that those clinical experts are all crypto-transphobes I suppose?

    Reem Alsalem UNSR Violence Against Women and Girls: "Very concerned about statements by the IOC at Paris2024 (M)ultiple international treaties and national constitutions specifically refer to women & their fundamental rights, so the world (understands) what women -and men- are. (H)ow can one assess fairness and justice if we do not know who we are being fair and just to?"



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog




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  • Registered Users, Registered Users 2 Posts: 7,479 ✭✭✭plodder


    What are you saying isn’t quite the case plodder? Just so I’m clear on
    what you’re saying. I just don’t want to be putting words in your mouth
    or making assumptions.

    This

    The learning outcomes are mandatory in all schools.

    "Schools will be expected to follow learning outcomes detailed in the document, even if they believe it clashes with their ethos."

    The fudge:

    "More latitude, however, will be given to schools in the detail of how these issues are taught and the resources used."

    and

    One of the learning outcomes says students should be able to “recognise the factors and influences that shape young people’s self-identity, such as family, peers, culture, gender identity, sexual orientation,
    race/ethnic background, dis/abilities, religious beliefs/world-views.”

    Another learning outcome says students should be able to “appreciate the breadth of what constitutes human sexuality, and how sexual orientation and gender identity are experienced and expressed in diverse ways”.'

    I'm just quoting the IT article that you linked. The list of factors and influences is taken from the document. Those are the ones emphasised …

    And this in the sub headline

    Move follows research which found sex education is out of date, too focused on biology and does not reflect the reality of young people’s lives

    "too focused on biology" and there's that phrase again that was used to justify the two failed referendums "reflect the reality of young people's lives".

    A lot of people are quite fed up with that way of thinking - that we just formalise whatever it is that (young) people already know, rather than give them guidance which they can choose to accept or reject.

    That's what I'm taking from the article you quoted. I assume they haven't misrepresented the document. It's pretty much what you would expect tbh, given the level of NGO influence over policy.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    I think the one thing that we should be able to agree on is that the Tavistocks was massively underfunded and underresourced for many decades - and this lead directly to child safety issue.

    The best outcome from the Cass report will be the significant increase in funding and resources for gender dyphoric people in general. This will lead to more timely and appropriate treatment to all people referred for consultations.



  • Registered Users, Registered Users 2 Posts: 8,784 ✭✭✭volchitsa


    Surely the problem is that since over 80% of young people presenting with gender dysphoria at the start of adolescence will desist by the time puberty is complete means that it's far too big a risk giving them to anyone, since the people behind the Dutch protocol do not claim to be able to identify those children whose GD will persist and those for whom things will settle down of its own accord? Particularly now that it's acknowledged that PBs are not irreversible.

    Reem Alsalem UNSR Violence Against Women and Girls: "Very concerned about statements by the IOC at Paris2024 (M)ultiple international treaties and national constitutions specifically refer to women & their fundamental rights, so the world (understands) what women -and men- are. (H)ow can one assess fairness and justice if we do not know who we are being fair and just to?"



  • Registered Users, Registered Users 2 Posts: 8,784 ✭✭✭volchitsa


    I've no problem with extra funding for appropriate resources. I think it's now in the process of being accepted that GIDS and a number of other institutions were being dictated to by activists over the clinical evidence, so hopefully the various clinics that replace GIDS will be more evidence-led and less activist-led.

    Reem Alsalem UNSR Violence Against Women and Girls: "Very concerned about statements by the IOC at Paris2024 (M)ultiple international treaties and national constitutions specifically refer to women & their fundamental rights, so the world (understands) what women -and men- are. (H)ow can one assess fairness and justice if we do not know who we are being fair and just to?"



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    Which maps very well to those who are actually treated. Clinicians are very well aware of this and look out for it and divert such children into more appropriate treatments. The system works and the data confirms this.



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  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    That is in no way accepted by reasonable people and is a slander of the medical profession.



  • Registered Users, Registered Users 2 Posts: 1,401 ✭✭✭Vote4Squirrels


    That would be Dr Cass, the former consultant paediatrician and former President of the Royal College of Paediatrics and Child Health ? As opposed to the "clinical experts" from Mermaids who sent out garments to destroy healthy breast tissue in vulnerable young developing girls ?





  • What we are witnessing with this report is the same disinformation we saw with anti-vax campaigners.

    Like the people dismissing WPATH files and the Cass Report, they argue there's a kind of medical "conspiracy" going on; that people cannot be trusted; that certain medical professionals are biased and compromised, and that "we know what's really going on" here; the "we know what the best medical advice should be based on our own limited data that just happens to agree with us" etc.

    It's funny to watch the same side who rightly identified and condemned the illogic of anti-vaxxers use exactly the same strategies to wholly dismiss or play down the WPATH files and Cass Report.



  • Registered Users, Registered Users 2 Posts: 8,784 ✭✭✭volchitsa


    I don't understand exactly what you're saying here: do you mean that clinicians do know how to choose the "right" patients to put on puberty blockers, ie they can identify the ones whose dysphoria is (almost) certain to persist after puberty?

    Or do you mean that they know to avoid the services where (in their opinion) anti trans activism means that children who need puberty blockers won't be given them no matter what?

    Reem Alsalem UNSR Violence Against Women and Girls: "Very concerned about statements by the IOC at Paris2024 (M)ultiple international treaties and national constitutions specifically refer to women & their fundamental rights, so the world (understands) what women -and men- are. (H)ow can one assess fairness and justice if we do not know who we are being fair and just to?"



  • Registered Users, Registered Users 2 Posts: 1,879 ✭✭✭Large bottle small glass


    Looks like you have now read the report or got a memo from headquarters.

    Can't challenge merit of report so let's discredit the author



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    They are experts who correctly identify the appropriate treatment for their patient. I couldn't have been more explicit on what I said.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    The report says fairly much what I expected it to say - which is not the same as what you think it says.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    I can see that the Cass report has got all your danders up by the gush of breathless posting it has elicited.

    I am happy that there are going to be more and better funded treatment centres for gender dyphoric individuals leading to quicker assessment and treatment. It should lead to less distressed people waiting for years before they get the interventions they need - which hopefully we can all agree will be a great outcome for gender dysphoric and transgender people. More and better - a result.



  • Registered Users, Registered Users 2 Posts: 11,063 ✭✭✭✭chopperbyrne


    Working from a flawed evidence base, and methodology.

    A clinician who followed all of the guidelines provided to medical professionals by WPATH would have been providing "the appropriate treatment" for their patients.

    Now, due to systematic reviews, it has become clear that the guidelines were incorrect.





  • There will be more treatment centres, but not with the current treatment pathway. That pathway was torn asunder by the report.

    Your attempts to minimize the Cass Report whilst at the same time spinning it as a positive outcome is transparent and predictable in equal measure.



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  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    The treatment path will be very much the same, but what will happen is people will get more external supports when they are found to not need gender affirming treatments, which again is better than the history of out the door and your on your own.

    You so want this to be the end of gender affirming treatments that you can't see that it is the exact opposite of what you imagine will be the outcome.

    Clinicians will continue to offer the best treatments for their patients and since transgenderism is real that will mean therapies that affirm that for those that need it. Anything less would be unethical.

    Post edited by Boards.ie: Mike on




  • No, the report marks the end of the so-called Dutch model of gender affirmation.

    It's an absolute 180-degree departure from the existing treatment pathway.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    You cannot deny treatment to people who have been identified as needing it - what that would look like is medical malpractice and no ethical clinician would sign up to it especially with the world looking on.

    The only basis on which you could attempt that is if you deny the reality of transgenderism which is an untenable medical position. Treatments will carry on much as before because clinicians were correctly identifying their patients.

    Post edited by Boards.ie: Mike on




  • It doesn't matter what either I think or you think when it comes to medical malpractice.

    What matters is what the experts think; what the clinical research supports.

    Dr Cass has established the criteria and that criteria must be implemented to ensure appropriate treatment and safeguarding of children.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    Your belief that there was widespread over treatment is simply not evidence based so your belief that the review will produce radically different outcomes is simply your wish.

    Post edited by Boards.ie: Mike on




  • I don't have any "beliefs" on this matter.

    The research is thorough and well-evidenced in its conclusions.

    It's the end of the gender affirmation model we all knew was damaging to begin with. It started with Mermaids and Tavistock and their gross negligence when it came to the standards of duty of care required when dealing with children and young people; and it ends here with this report.

    Dr Cass' conclusions are fair and reasonable about how patients should be safely and responsibly treated going forward, without any external ideological infringement upon the recommended treatment protocols.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    If that is true then transgender people will be mighty grateful because they will get faster and better gender affirmative treatments.

    Post edited by Boards.ie: Mike on




  • If that is true then transgender people will be mighty grateful because they will get faster and better gender affirmative treatments.

    No, this is what the Cass Report is expressly against.

    I would suggest reading at least the conclusions of the Cass Report from the website I linked to above, as it contains all the relevant details as well as a link to the almost 400-page report.



  • Registered Users, Registered Users 2 Posts: 13,779 ✭✭✭✭hotmail.com


    The delays don't do any harm.

    Most of these people desist from changing their gender and stop attention seeking when they become older teenagers.



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  • Registered Users, Registered Users 2 Posts: 13,779 ✭✭✭✭hotmail.com






  • The Cass Report also detailed how adult gender clinics refused to cooperate with Hillary Cass when she asked them for their data so she could do long-term follow-up. In the report, it says they "thwarted" her efforts to gather this information.

    This is not the action of people acting in good faith, refusing to provide essential data. It's definitely not the actions of people who care about the actual treatment outcomes of the people under their care.



  • Registered Users, Registered Users 2 Posts: 1,283 ✭✭✭carveone


    The thing about GnRH agonists is that their use as puberty blockers is off-label (ie: not specifically approved for that use). This doesn't prevent physicians from prescribing them however there are supposed to be rules. At least there are in the UK and presumably Ireland; this isn't the US or, god help us, Canada. The rules involve things like evidence of efficacy or where prescribing is part of approved research. Good thing Tavistock was adhering to ethical guidelines and keeping close track of patients and following up right? No? Good stuff.

    When the NHS set out its clinical policy banning the use of GnRH agonists as puberty blockers it was an immediate signal to not only doctors but, more importantly, their insurers that the ability to use this stuff off-label was now over. In my opinion, a private doctor prescribing it would be looking at practically infinite personal liability if their patient wound up with, say, liver cancer. If you were an medical insurer in Ireland (which isn't exactly a country known for not suing at the drop of hat) would you be insuring this risk?

    The only way GnRH agonists will be prescribable now is if they are specifically approved. For which you'll need a ton of evidence. Which, so far, the gender clinics either don't have or are refusing to yield.



  • Registered Users, Registered Users 2 Posts: 1,283 ✭✭✭carveone


    As an aside, I've been getting flashbacks to my childhood reading some of this stuff. I'm in my 50s now but when I was young I was quite short. I was under 5ft until I was about 15. Late developer I suppose but I was 5'8 at 18 which seems pretty reasonable to me.

    Anyway, something that arose at the time was to express concern about shorter children, especially boys (more on this in a second). During the 1970s, these concerns - short stature might cause social and psychological burdens - became medicalised with the use of growth hormones, giving doctors the ability to intervene medically with something that wasn't a medical condition. Cosmetic endocrinolgy if you like.

    Very very expensive of course (ka-ching!). Arguments about ethics and suitability. Off label use of experimental treatments on children with low followup and very little evidentiary reporting. Nothing familiar there.

    So bad news - the growth hormones were taken from the pituitary glands of corpses and not always inadequately screened. A percentage of children wound up with Creuzfeldt-Jakob disease as a result (the bovine version is mad cow disease - there was use of pituitary glands of dead cows to boost the growth rate of live ones, same issue). That's a nasty way to die.

    So why the interventions about short boys? One reason was to make them better conform to gender stereotypes - to be normal at any cost (that's the title of a very depressing book about this which I found much later in my life). The intervention was mirrored for tall girls - tall girls were deemed unfeminine enough to get a man.

    And there's an unpleasant overlap with gender identity. John Money – he's one of the founders of modern theories of gender identity and advocate of medicalization in that area – was a strong advocator that short boys be given HGH, because that might help stop them turning out to be homosexual. Of course, Money was a total monster but he was also expressing the attitudes of the time - short boys and tall girls would turn out to be gay. And you simply can't have that.



  • Registered Users Posts: 849 ✭✭✭MilkyToast


    Its criminal that a medical matter has been turned so highly political by a failed political ideology who see the only path to power as stoking culture wars.

    This "you're engaging in a culture war" narrative is tired.

    I didn't assert that everyone suddenly has an innate gender identity. I didn't suggest that anyone has a frame of reference to know what it's like to 'feel like' the opposite sex. I didn't assert that people who claim to have this identity really do, and that they should be treated legally like the opposite sex or maybe, sometimes, like no sex at all. I didn't start letting men who claim they feel like women into sports, prisons, shelters, bathrooms, changing rooms, groups, lesbian bars, or anywhere else. I didn't assert that lesbians must find men who say that they feel like women attractive or they're 'sexual racists'. I didn't push the belief of this concept into schools and education. I didn't insist that people use the words of my preference over words of their own to assuage people's feelings. I didn't mandate or heavily suggest that anyone put 'pronouns' in their email signature. I didn't start telling little children with no firm grasp on the concept of sex that they could be whatever sex they want. I didn't start giving harmful, cancer causing, vagina atrophying, fertility destroying, development-halting drugs to children and vulnerable adults with barely any assessment. I didn't offer young girls with bodily discomfort 'binders' to damage their bodies with. I didn't sit around on the internet waiting for teenagers to express mental distress so I could swoop in and tell them they're trans and here's a script for your parents. I didn't use my position as a leader, celebrity or politician to push these things because my PR crew told me to. I didn't tell any children that there are expectations based on their sex for how they will behave or what activities or toys they prefer, and that if they don't meet those expectations then maybe they weren't that sex to begin with. I didn't give any 'woman of the year' awards to men.

    I merely noticed this war on culture, and objected.

    It's not the same.

    “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience." ~C.S. Lewis



  • Registered Users Posts: 849 ✭✭✭MilkyToast


    The only thing you know about me is that I don’t believe in gender identity and I’m against medical harm visited on children, actually.


    If you have to make me some imaginary fascist bogeyman to support your worldview, maybe your worldview is shít.

    “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience." ~C.S. Lewis



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  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog






  • Probably the best response I have ever seen to that question.





  • That's the very definition of gaslighting.

    You then went on to say:

    My world view is compassionate, give it a go.

    All dictatorships argue that they act benignly, to act in favour of "what is Good for everyone" — with a capital G, as their Good is better than everyone else's good.

    That's precisely what motivates certain people to control everyone else; the belief that they know best and the need, they feel, to enforce that belief upon everyone else.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    I believe in listening to what people say about themselves and giving them all the help possible to achieve what they see as their own self image. This is the basis of my compassion for others.

    I know at least one adolescent who is transgender and I will do everything I can to support them in their journey and see that they have access to the services they need to achieve that.

    I will do everything I can to shield them from people like yourself.

    Post edited by Boards.ie: Mike on




  • What matters is objective, scientific medical evidence — not personal feelings and personal preference.

    The very fact you just stated that independent medical evidence doesn't matter because in your own words just now, you "will do everything you can to shield them" from the best available medical evidence, says far, far more about your position than it does about mine.



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  • Registered Users, Registered Users 2 Posts: 13,779 ✭✭✭✭hotmail.com






  • It's not compassionate to lie to people.

    You have to be truthful and help people as best possible within that framework.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    If you are not listening to the personal experience of real flesh and blood people you have nothing to base your diagnosis on. You cannot treat a person if you do not accept their personal account of themselves.

    The reality is that medicine has long since accepted the reality of transgenderism. You think that the field is based upon makey uppy soft feeling - not at all. If you don't accept the reality of transgenderism you have nothing useful to contribute to the debate because you are denying medical reality.

    I fully understand that most people presenting with gender dysphoria will not go onto seek medical interventions to realign their bodies to their gender - but as I have said many times, this is also totally understood in the medical field because treatment with hormones and surgery is very much the exception rather than the norm. Up until recently it was uneffically difficult to progress in treatment and most people with gender distress were subjected to horrific treatments which attempted to realign the self image with societies view of "normality". Fortunately those dark days have largely been consigned to history.

    I stand in my support for people self identifying as gender dymorphic and seek the best and most appropriate treatment for them.

    Post edited by Boards.ie: Mike on


  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    Which is why only a small proportion progress in treatment, and why services filter for this reality.





  • Put simply, you have decided to reject the evidence of the Cass Report and WPATH files because you don't like the conclusions.

    That's a point of view. But it's a point of view that is ethically unacceptable given the best available evidence.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    I am sorry but who is lying to gender dymorphic people ?

    You are lying to them by not accepting what they say about themselves.

    Post edited by Boards.ie: Mike on




  • Do you support medical evidence and research, or do you not?

    Or is it a case that you only support medical "research" when you agree with its conclusions?

    Medical intervention isn't a la carte; you cannot just decide which parts you accept and which parts you do not accept.



  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    I have accepted the broad findings of the Cass report but the WPATH files is a politically motivated hatchet job which needs sending to the toilet bowl where it belongs.

    Post edited by Boards.ie: Mike on


  • Registered Users, Registered Users 2 Posts: 6,626 ✭✭✭Shoog


    I thought the conclusion of the Cass report was that we need more evidence, not that the evidence supported your transphobia.

    Post edited by Boards.ie: Mike on




  • Which specific allegations against the WPATH files do you have problems with?



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