Ok, Tony nerd-sniped me, I read the USPATH-WPATH response to the New York Times puberty blockers story. (God and I haven't even gone through his thread about the Reuters story yet.)
It is really bad! About half-way through I gave up writing proper notes in the margins and just put things such as "Wow!", "lmao", "!!!!!!!" and "Hahahahaha hahahaha hahaha haha" (this last one formed a pleasing triangle shape). Let's start at the top.
It seems WPATH decided to put their strongest arguments at the top, even though these are the
worst arguments in terms of actually dealing with the subject matter, as they're ad hominem distractions. Quotes are from
the PDF published on WPATH's website (also attached for archival purposes).
WPATH said:
the article supports inaccurate narratives that puberty blocking medicines are conclusively harmful to long-term bone density or other health outcomes
The adjective "conclusively" is doing a lot of work here. As has been mentioned in this thread, the evidence around puberty blockers is extremely poor. In particular, there have not been good-quality longitudinal studies (which follow the same patients over time) of the bone health of transgender-identified children who receive puberty blockers.
WPATH said:
The cited bone expert from Mayo Clinic, Dr. Sundeep Khosla, MD, is an adult endocrinologist who does not work clinically with transgender youth and has only a single publication on transgender health. This
publication is not a research study, but a brief review commentary on the issue of bone density in adult transgender people.
This is a distraction technique. What is important is that
Khosla is an expert in bones and how they develop, with one of his research interests specifically being "sex steroid regulation of bone metabolism". He doesn't need a special gold star from WPATH for that expertise to apply to transgender-identifying patients any more than he needs a fatwa from the ayatollahs for it to apply to Muslims.
I skimmed the linked study (
it's at Sci-Hub here); it's basically two experts on bone health setting out what should be kept in mind in the treatment of transgender-identifying patients, and the role of sex hormones in bone health, and it doesn't pretend otherwise.
WPATH said:
The anecdote provided of an adolescent who began, and then stopped pubertal suppression due to bone density loss lacks important details, including age and pubertal stage at initiation of puberty blockers, length of time on blockers, baseline bone density (“Z-score”), and whether the bone density comparison was made to identified gender or birth-assigned sex. Additional important information not provided includes calcium intake, and vitamin D intake and level, as well as level of physical activity, all of which play a substantial role in maintenance of bone mineral density.
To be clear, WPATH is criticising the New York Times for not including detailed clinical information on one interviewee in a
news feature. Another distraction.
WPATH said:
The single expert who performed the literature review, Dr. Farid Foroutan, PhD, is an epidemiologist with no experience in clinical medicine, child and identity development, bone density, or any aspect of the field of transgender health.
Instead,
Foroutan is an expert in evidence synthesis. One of his colleagues at McMaster University is Romina Brignardello-Petersen, who was one of the two authors of Florida's literature review. I said
a while back that it was beneficial for her and co-author Wojtek Wiercioch not to have been involved in gender medicine as it meant they could come to the topic fresh.
If an expert is otherwise involved in pediatric medical transition, they will likely be either for it or against it. WPATH would obviously completely reject any "terf" expert, so really what they are complaining about is that the NYT spoke to people who weren't fully committed gender quacks.
WPATH said:
In fact, Dr. Foroutan recently co-authored a
paper which highlighted this very concern [about clinical studies being misinterpreted by non-experts]
Not really what that paper is about but whatever, WPATH are obviously not expecting people to check their sources.
WPATH said:
We were surprised to see reference to a subjective statement from Dr. Catherine Gordon, MD regarding “getting behind” on bone density,
Quite a bizarre attempt to distract people. Presumably no-one beyond some fringe lunatics is disputing that puberty blockers, er, block puberty and so those taking them will "get behind" their peers who are developing normally?
WPATH said:
A subsequent commentary co-authored by Dr. Gordon and published in November 2022 in JAMA Open Access stated, “Concerns about skeletal losses become less significant in an adolescent with active suicidal ideations. Although the significance of the risks may be unclear, there is strong evidence regarding the benefits of GnRHa in transgender youth: it can be a life-changing and lifesaving treatment for a vulnerable population who is at high risk for anxiety, depression, and suicide.”
This is a good one! Gordon's comments quoted by WPATH just say: "It doesn't really matter if puberty blockers affect bone health because the decrease in suicidality is worth it." Which is not the argument WPATH is pretending to make in this statement. Anyway, regarding the quoted comment, the reviews make clear we don't know whether puberty blockers reduce suicide risk, because the existing research is so poor.
WPATH said:
Anecdotes are provided about two teens who were found to have severe osteoporosis after 1 and 3 years of blocker treatment. In both cases, a baseline bone density test was not done. It is unlikely that such a degree of severe osteoporosis would develop after these short courses of treatment, and there were likely other pre-existing factors at play.
Yes, and what does this say about the gender docs actually practising in the real world?
WPATH said:
The blockers themselves do not impact bone density. Bone density is impacted by the fact that sex steroid production is temporarily halted when puberty blockers are initiated.
This is technically true, but it is the puberty blockers that prevent the production of sex hormones. (Obviously?) No puberty blockers, and sex hormones are produced normally.
WPATH said:
Many types of blockers are routinely used in combination with estrogen well through adulthood without deleterious effects on bone density. This has been the common practice for treatment of adult transgender individuals for decades
This isn't the point, of either the New York Times story or this WPATH response? Funny because earlier WPATH was criticising Khosla (wrongly) because his paper they (mis-)cited was about adults rather than children. Just another irrelevant statement intended to distract.
WPATH said:
Experts in the field are indeed concerned regarding bone density among youth using puberty blockers.
Fucking LOL. We are 8 paragraphs into WPATH's response and then they say "actually experts are concerned about puberty blockers affecting bone density". It is the absolutely classic tranny organisation response that, when the tide turns, they pretend they've been swimming in the other direction all along. They have always been at war with Eastasia.
WPATH said:
Transition reversal, especially when unrelated to external factors such as discrimination or rejection by family, is rare.
By "transition reversal" they mean detransition. We have little data on the prevalence of detransition because detransitioners are ignored; in studies they are "lost to follow up" or simply excluded because they no longer identify as transgender.
This next paragraph is a real belter. First the preamble:
WPATH said:
The findings of the seven citations provided at the end of the paper require a nuanced interpretation by clinician-scientists familiar with this population and subject matter.
Ok, ok.
WPATH said:
Many of the studies used sex assigned at birth, rather than identified gender, as the comparitor.
!!!!!!!! Well obviously? Males are still male. Or should it be that, once boys decide they are transgender, they should have the bone density of uwu soft girls?
Also lol, WPATH, concerned with rigour, spelt "comparator" wrong. Took them over a week to get a statement out and they couldn't be bothered to even spell-check it.
WPATH said:
Many of the differences found failed to reach statistical significance, and of those that did, many are of questionable clinical significance.
This is what people have been complaining about! Literally every systematic review says "the research is shite, puberty blockers could turn you into a space alien from all it tells us."
WPATH said:
Any such risk must also be taken into context with the substantial benefits of treatment, and harms of not accessing such treatment, including high rates of mental health disorders and suicidality.
Ah, yes, suddenly the research is
not shite. Fuck me.
I mean, fucking hell, the reviews don't say "the research is rubbish on bone health but the research on everything else is just perfect". They say "there is no evidence for any of this".
WPATH said:
Finally, the authors of this article suggest that “England’s National Health Service last month proposed restricting use of the drugs for trans youths to research settings.” In fact, the pivot that the National Health Service took was to enroll ALL youth initiating puberty blockers for treatment of gender dysphoria into a prospective research protocol so that more comprehensive data might be collected.
This is the most blatant misrepresentation of what is proposed in regards to puberty blockers by NHS England. The original NYT quote is correct. The proposal is to move from a situation where some kids are given puberty blockers and no research is done on them to find out if it was a good idea, to a situation where puberty blockers will only be given in exceptional cases and
even then only if it is part of a research programme so that we can find out conclusively what these drugs do.
WPATH said:
Misinformation about the science behind the care of trans youth, such as presented in this article, can be and has been used to justify political actions or even violence against the trans and gender diverse community. With growing efforts to ban medically necessary gender affirming care for trans youth, and attacks rise such as was recently seen in the mass murder at Club Q in Colorado Springs, CO, measured and responsible journalism is ever the more essential.
Despicable.
