Fucken fell for it again Kiwifrens.
Tony retweeted Vanessa Vitiello Urquhart / Evan Urquhart. Urquhart is a try-hard lesbian TIF who blogs at assignedmedia.org and who is just really bad at it, like really bad, worse than Tony bad. Embarrassing.
Anyway, she’s written a blog post supposedly about what’s going on in the UK (England, really), Sweden, Finland, and Norway. "I’m a reporter, not an activist. I care about the truth", Urquhart claims, and then proceeds to share something that is easily shown to, er, not be the truth.
@assignedmedia, tweet 1699374615691178294 (
archive)
Assigned Media (Evan Urquhart) (@assignedmedia) · Sep 6, 2023 · 10:50 AM UTC
When the information that a few European countries were sounding new notes of caution on gender-affirming care, of course I took it seriously. I'm a reporter, not an activist. I care about the truth.
Assigned Media (Evan Urquhart) (@assignedmedia) · Sep 6, 2023 · 10:52 AM UTC
At the start it was very difficult to find good English-language information. This itself was something of a red flag- all these anti-trans activists were suddenly discussing goings on in Sweden and Finland in English, but there were no English sources of news?
Assigned Media (Evan Urquhart) (@assignedmedia) · Sep 6, 2023 · 10:54 AM UTC
So eventually I dug into it, because no one else seemed to be. And one of the top questions on my mind was "Are they seeing new information? Is there new data?"
And there was not.
Assigned Media (Evan Urquhart) (@assignedmedia) · Sep 6, 2023 · 10:56 AM UTC
I wrote this all up, but essentially politics exists in European countries as well. There's nothing new in the approach of these countries, what's happened in them has been VASTLY overstated and spun by activists, and the science hasn't changed.
Assigned Media (Evan Urquhart) (@assignedmedia) · Sep 6, 2023 · 10:57 AM UTC
It does seem that in the UK many people have functionally lost access to transition, however. Not because of new research, but because the response to the NHS being overburdened has been to further reduce care.
Assigned Media (Evan Urquhart) (@assignedmedia) · Sep 6, 2023 · 11:01 AM UTC
The debate over gender-affirming care is whether it should be subject to made-up, constanly shifting standards different from those in other areas of medicine, or whether the normal rules, which unambiguously support transition as well-established and medically necessary, apply.
What’s Going on With Gender-Affirming Care in Europe? (
archive)
Edit: Sorry, I did spoiler the bulk of my very long commentary on the article but then it fucked up the quote blocks. There's a TLDR at the end.
The intro is very bizarre, suggesting that the only reason why people who are skeptical of medical transition point to Europe is because Europe has some kind of blessed aura. Europe’s a big place! 50 states with as many languages.
What’s funny though, is that Urquhart tells her readers to reject one weird broad-brush treatment of Europe and adopt her own broad-brush treatment of Europe. Especially so that when opponents of medical transitions refer to Europe, they are very specifically pointing to the systematic reviews conducted by a few European national health services, and not invoking some mystical "Europhilia".
Enough waffle, let’s dig in, with the same country-by-country approach the article uses. Hope you’ve got your bingo cards ready!
United Kingdom
a right-wing Tory government attempting to
dismantle all human rights protections for trans people, in violation of international law that protects them
False. Trans-identified people are separately protected under the Equality Act 2010 with the protected characteristic of "gender reassignment". Clarifying the existing and separate protected characteristic of "sex" to mean biological sex (and not "legal sex") would resolve ambiguities on (and the hesitation to provide) single-sex spaces, and give trans-identified females (such as Urquhart!) more protections.
Urquhart also makes a stronger claim here than her source, and is accordingly
more wrong. This will become a theme!
Again, Urquhart can’t even relay the claims of her sources without exaggerating them and getting it wrong in the process. That something is not ready does not mean that no effort has gone into the thing.
Here’s the NHS consultation response regarding child and adolescent gender dysphoria services published in early June, with the consultation having taken place late last year and a new service specification having been published.
The very real issues with the GIDS service, combined with years of anti-trans activism and a vicious anti-trans streak in the UK tabloid press resulted in an independent review led by pediatrician Hilary Cass. This review produced an
interim report that recommended closing the GIDS clinic and creating multiple regional centers where young people with gender dysphoria could be treated in a timely fashion, allowing any co-occurring mental health issues to be addressed. In the intensely anti-trans political environment of the UK, however, the review has not succeeded in prompting the creation of high quality regional centers that treat youth individually and cut down wait times, and the GIDS clinic remains open with wait times of three years or higher for a first appointment.
Perhaps the clearest indication that Urquhart does not understand the situation in England. The NHS is not an organisation that is able to make very big changes very quickly. This is especially true when it comes to child and adolescent gender dysphoria, where the only existing clinic practised a treatment model that has now explicitly been abandoned.
the primary failure at Tavistock was of the NHS refusing to provide sufficient resources to meet the needs of GIDS patients. This is perfectly clear when you read the Interim Cass Report in full, but it presents an inconvenient complication for those with an ax to grind against gender-affirming care.
I knew we’d get to cross off that "Urquhart didn’t read the Cass interim report" square on the bingo card, but I didn’t think we’d get to cross it off after a sentence that included "when you read the Interim Cass Report in full"!
On the matter of insufficient resources specifically, Cass writes (in the summary, 1.12) that there is a "lack of consensus development on the clinical approach" and that "capacity constraints cannot be addressed through financial investment alone".
Urquhart claims this is why GIDS was not up to the task, and ignores the meat of the Cass interim report. But what does Cass say about the clinic approach of GIDS, that of affirmation that a child was "born in the wrong body"?
1.14. Primary and secondary care staff have told us that they feel under pressure to adopt an unquestioning affirmative approach and that this is at odds with the standard process of clinical assessment and diagnosis that they have been trained to undertake in all other clinical encounters.
1.16. Another significant issue raised with us is one of diagnostic overshadowing – many of the children and young people presenting have complex needs, but once they are identified as having gender-related distress, other important healthcare issues that would normally be managed by local services can sometimes be overlooked.
3.13. […] There were different views held within the staff group about the appropriate clinical approach, with some more strongly affirmative and some more cautious and concerned about the use of physical intervention.
4.15. Clinicians and associated professionals we have spoken to have highlighted the lack of an agreed consensus on the different possible implications of gender-related distress – whether it may be an indication that the child or young person is likely to grow up to be a transgender adult and would benefit from physical intervention, or whether it may be a manifestation of other causes of distress.
4.20. Some secondary care providers told us that their training and professional standards dictate that when working with a child or young person they should be taking a mental health approach to formulating a differential diagnosis of the child or young person’s problems. However, they are afraid of the consequences of doing so in relation to gender distress because of the pressure to take a purely affirmative approach.
OK, that’s just Cass. But Urquhart wraps up her United Kingdom section without mentioning
the two systematic reviews conducted by the National Institute for Clinical Excellence (NICE). These two documents, far more so than the Cass interim report or the new service specification, are the ones with the greatest consequences for clinicians around the world.
Here’s what NICE said about puberty blockers — the only intervention offered by GIDS:
The results of the studies that reported impact on the critical outcomes of gender dysphoria and mental health (depression, anger and anxiety), and the important outcomes of body image and psychosocial impact (global and psychosocial functioning), in children and adolescents with gender dysphoria are of very low certainty using modified GRADE. They suggest little change with GnRH analogues from baseline to follow-up.
In other words: the existing research on treating gender dysphoria in children and adolescents with puberty blockers is of the lowest possible quality, and there is little change in outcomes after children have been put on puberty blockers.
And what did NICE say about treating children and adolescents with cross-sex hormones for gender dysphoria?
Any potential benefits of gender-affirming hormones must be weighed against the largely unknown long-term safety profile of these treatments in children and adolescents with gender dysphoria. … All results [on potential benefits] were of very low certainty using modified GRADE.
Again, the existing research is of the lowest possible quality.
Tony likes to bitch about GRADE, but for practical purposes it is just a measure of
how much trust you can put in the results. And NICE suggests you should put
very low amounts of trust into the existing research on puberty blockers and cross-sex hormones for treating gender dysphoria in children and adolescents.
As such, puberty blockers are no longer routinely prescribed to gender dysphoria children and young people.
Sweden
As in many other places,
a rising far-right party, once considered beyond the pale, has recently gained political influence in Sweden. And, as in the US and the UK, activists opposed to transgender acceptance have sought for years to turn Swedish public opinion against gender-affirming care for youth. In 2019,
a series of documentaries featuring detransitioners and anti-trans activists introduced the moral panic over gender-affirming care to the Swedish public.
Urquhart mentions "a rising far-right party" in a transparent attempt to tar the decisions by doctors and civil servants in the Swedish health service as being motivated by far-right impulses. Except the PBS article Urquhart link to was published on October 18 2022, long after all of the main developments to roll back affirmative medical transition in the Swedish health service.
Urquhart relies on another trans activist for her details about Sweden, someone with the same motivated reasoning and wearing the same rose-tinted glasses. Urquhart calls it "the most accurate English-language explanation" of the Swedish situation, but instead she could have gone straight to the Swedish Ministry of Health and Welfare (NHBW) as they published
a summary of the new national guidelines in English.
At group level (i.e. for the group of adolescents with gender dysphoria, as a whole), the National Board of Health and Welfare currently assesses that the risks of puberty blockers and gender-affirming treatment are likely to outweigh the expected benefits of these treatments.
Why did NHBW make this decision? Because they commissioned a systematic review, which has also been
published officially in English:
the long-term effects of hormone therapy on psychosocial health could not be evaluated … Evidence to assess the effects of hormone treatment on the above fields in children with gender dysphoria is insufficient.
Does Urquhart mention the Swedish systematic review? No!
Finland
Minors in Finland have never had meaningful access to puberty blockers or hormonal treatments for gender dysphoria.
What an odd thing to say, because
Finland adopted the "Dutch protocol" of assessment and puberty suppression in 2011. Presumably Urquhart believes the "Dutch protocol" is far too conservative and that the benchmark of "meaningful access to puberty blockers or hormonal treatments" is the US model of prescription on demand?
Urquhart claims:
Finland, provision of puberty blockers and other medical treatments seem to have been so rare as to be almost nonexistent.
While Finland’s leading gender clinician, Riittakerttu Kaltiala-Heino (quoted by Lisa Selin Davis), says:
In Finland, for patients who fit the profile of participants in the Dutch study, after a prolonged period of evaluation, and with a multidisciplinary team including a psychiatrist, psychologist, social worker and nurse, puberty blockers may be started near the onset of puberty and cross-sex hormones may be possible starting at age 16. Social transition for young people is not advised. But even for those with adolescent-onset gender dysphoria, medical intervention isn’t completely off the table. "It’s not that nobody can get it, but it is that there is a very intensive clinical evaluation taking place with the young person and their parents," Kaltiala-Heino said. Assessments take place at two nationally centralized gender identity clinics, which also initiate any treatments and follow-up the patients over the first years of gender identity-based treatment; gender surgeries are offered only at one center.
Let’s go back to the Finnish guidelines, which Urquhart does not quote. Here’s how
the Finns describe the then existing regime (SEGM translation):
In clear cases of pre-pubertal onset of gender dysphoria that intensified during puberty, a referral can be made for an assessment by the research group at TAYS [Tampere] or HUS [Helsinki] regarding the appropriateness for puberty suppression. If no contraindications to early intervention are identified, pubertal suppression with GnRH analogues (to suppress the effect of gonadotropin-releasing hormone) may be considered to prevent further development of secondary sex characteristics of the biological sex.
And the new regime:
In light of available evidence, gender reassignment of minors is an experimental practice. Based on studies examining gender identity in minors, hormonal interventions may be considered before reaching adulthood in those with firmly established transgender identities, but it must be done with a great deal of caution, and no irreversible treatment should be initiated.
Norway
If you watched the Trans Train documentary (which Urquhart dismisses as anti-trans) you might remember Anne Wæhre, the Oslo university clinician who
expressed concern over the same huge increase in trans-identifying girls as was being seen in Sweden (and everywhere else). At that point, in late 2018, the youth gender clinic at Oslo University Hospital had 350 patients, which in a country of just over 5 million, and a relevant youth population of perhaps 600,000, is quite significant.
Yet Urquhart’s tactic here is again to say that "oh not many kids were getting puberty blockers so this country doesn’t count".
Norway has long imposed significant barriers to accessing gender-affirming care for youth. … It is against this background that the concerns expressed in a March report by Norwegian health authorities ought to be understood. The concerns did not represent any new limitation on care but rather a justification for continuing with the current limitations, which are extensive.
Except Norwegian GPs (aka family doctors or PCPs in the US) could refer children and young people directly to the gender clinic in Oslo with a relatively short waiting time of 3–9 months, or
prescribe hormone treatments themselves. Allowing GPs to dish out puberty blockers does not sound like a "significant barrier" to me.
Urquhart says that the Ukom report "did not represent any new limitation on care but rather a justification for continuing with the current limitations". You can only come to this conclusion if you have not read the Ukom report.
Ukom urges that the national Ministry of Health clarify which parts of the health service have responsibility for what — ie the dual structure of both Oslo University Hospital and local GPs being able to prescribe puberty blockers should come to an end.
In addition, Ukom says that there should be standard guidelines for gender dysphoria assessments and criteria for starting hormonal treatment — something that should sound eerily familiar to anyone with knowledge of the situation at GIDS.
As well, Ukom recommends the commissioning of a systematic review of the evidence and the consideration of recent systematic reviews carried out in other countries.
On the evidence for hormonal intervention in children, Ukom says:
The knowledge base, especially research-based knowledge, for gender confirmation treatment (hormonal and surgical) is insufficient. Little is known about the long-term effects. This applies in particular to the teenage population, who make up a large part of the increase in referrals to the specialist health service in the last decade. This means a new population for the health services where documentation about treatment effect, side effects and prognoses is missing or weak.
Ukom’s medical director
told Jennifer Block: "We’re concerned that there may be undertreatment, overtreatment, and the wrong treatment, with variation in safeguarding and the extent of multidisciplinary involvement, posing a threat to patient safety."
Urquhart makes a big deal out of the fact that a "a full section of the report discusses a “gap in expectations" between patients and parents who believe their right to health care includes a right to access gender-affirming care”.
But is this a surprise? Ukom writes:
Parts of the patient population have an expectation that the right to treatment must be fulfilled based on a subjective need. Thus, it becomes a source of frustration when the Norwegian health system is set up so that requirements for expected benefit, effect and safety are the triggers for the type of help and treatment.
ie Patients are frustrated when they get denied treatments that are not supported by the evidence.
Where might these children and adolescents get this expectation from? Kids in, say, Norway will very likely have excellent English, particularly the mentally ill terminally online types most susceptible to transgenderism. Online they will find stories of kids receiving puberty blockers at their local gender clinic after one or two appointments. Then they turn to their own national health service and despair that it’s not like a US gender clinic. Urquhart doesn’t reckon with the expectations set by US gender clinicians, she just takes it as a given.
Conclusion (and tldr)
From the beginning, the national health apparatuses of most European countries have taken a cautious approach to gender-affirming care
This is only true in comparison to the US, which is the Wild West of puberty blocker pill mills.
The existence of activism to limit care in Europe does not ultimately have any bearing on the medical evidence, and none of the countries mentioned have introduced any new evidence calling into question the efficacy or safety of gender-affirming care for minors. Instead, they have issued reviews of the available evidence holding gender-affirming care to standards not used for other treatments as a way of justifying their refusal to make gender-affirming care more accessible to patients who need it.
Urquhart has studiously ignored the systematic reviews conducted by England, Sweden and Finland. This is the first time she’s mentioned them in the entire article!
And here we find the kicker, and exactly the claim that Tony makes: "holding gender-affirming care to standards not used for other treatments". Puberty blockers and cross-sex hormones sterilise children. If you are proposed a "treatment" with such severe and permanent side effects, you have to show that they have a clear benefit, but gender researchers have entirely failed to do that, which is why the systematic reviews say that the quality of these studies is "very low".
Yet Urquhart insists that the systematic reviews are "a way of justifying their refusal to make gender-affirming care more accessible to patients who need it". How can someone
need something that has not been shown to provide a benefit!?
Ultimately we come back again and again to the same point. The adults, such as Tony and Urquhart, did not need this "life-saving care" as children. They grew up and lived full lives before deciding to live as the opposite sex.
But they say that children need these treatments as a cover; if there are innocent children who were born in the wrong body, Jackie Public will think that the adults are just the born-in-the-wrong-body children who survived into adulthood, and so there is no need to probe the psychological reasons that an adult might choose to have their genitals mutilated and force themselves into areas reserved for the opposite sex.
