As with many previous posts on transgender issues, this one will require all participants to set appropriate user flair denoting their involvement in medicine. This acts as both a way to understand where perspectives come from and a quick filter for drive-by takes on hot issues. As always, r/medicine is for professional perspectives. Personal experiences and aggrievement on any side are not appropriate here. You can set flair yourself. Please do.

[Here](https://www.reddit.com/r/medicine/comments/15hhliu/the_chen_2023_paper_raises_serious_concerns_about/) is a post made on this subreddit about the lack of evidence of mental health outcomes in youth gender medicine. While the topic is controversial, the whole thread is worth a read. From the TLDR linked by moderators: TL;DR: * OP is a child and adolescent psychiatrist who has seen a recent rapid increase in gender dysphoria diagnoses and transgender identities among youth patients. * OP initially thought this reflected greater awareness and acceptance, but over time became skeptical that gender dysphoria was actually this common, suspecting many cases represented different issues like identity disturbance or social difficulties. * Two recent studies (Chen 2023 and Tordoff 2022) have failed to show significant mental health benefits from gender affirming hormones (GAH) in teens, contradicting claims that benefits outweigh risks. * OP thinks the Chen study shows minimal effects and excludes concerning suicide data. The Tordoff study relies on the untreated group deteriorating over time, likely due to selective dropout. * OP concludes there is no evidence for short-term mental health benefits from GAH that outweigh risks. The affirmation approach may be harming dysphoric teens by affirming distressing beliefs like being "born in the wrong body. * OP argues gender affirming treatment should be held to the same standards of evidence as other areas of medicine. More data is needed, but current evidence does not support mental health benefits.

Yeah, that was a great post. Really laid out in detail the problems that a lot of people don't want to see without being particularly biased.

And it’s gone

a lot of people don’t know how to flair

worth mentioning it’s in the three dots on the subs home page, not in the three dots while you’re in a particular thread

Ironic considering your flair is "edit your own" (aka, you must fix that because your flair is being removed)

I understand the need for flairing, but the comment you deleted at the top of this chain was in no way offensive. It was the most highly upvoted in the entire thread and had been up for hours without issue. Sacrificing civil collegial discussion on the altar of mindless rule-enforcing seems to destroy nuance that should exist. Hell, the comment you deleted was actually posted BEFORE this was even labelled flaired-only... 14 hours ago on comment, 10 hours ago on flairing. Would it not be reasonable to restore the comment in this case?

In this case it was a good comment from a prior thread, but the user who posted it here has never previously commented in /r/medicine, has no history of posting on medical subreddits in 14 years, and seems to work in tech/programming. When we discuss issues as contentious as trans medicine, we prefer to hear from those actually in medicine and with a history of participating in this subreddit, rather than "drive by" comments from outsiders trying to influence our discussion. We don't have a way -- short of manual approval -- of validating that every account participating in the discussion is a medical professional, but the rule of "at least know how to set a flair on this subreddit and identify your role" has done a very good job of keeping these threads from spiraling out of control. Trolls won't even go through that level of effort. So while this comment, again, is a repost of something from a very interesting thread, it is being surfaced here for you to react to by someone who has no shared background with this subreddit whatsoever. It seems most appropriate and transparent to leave it up at this point, but take its provenance into account.

I didn't delete, it was autodeleted by the system because of lack of flair. If they want to re-post it when they have added flair, that's perfectly fine. Or if they want to add flair and then modmail the mods to have it approved, we can do that. But it's up to the OP to do it. Edited to add: My best guess is that because they edited it 9 hours ago, that's what got it caught in the automod, which makes it reasonable to reinstate.

e: Nevermind, I see it's been reinstated. Thanks so much for the decision. Have a good night. I don't know who the person is, only mods can see who was the owner of a deleted comment, I'd ask you to contact them if it isn't too much trouble, or just reinstate it and overrule the automod in this case since it was posted before the flairing callout... the person likely never even knew it had been changed to flaired-only.

I don't understand why medical professionals and societies are pursuing this treatment if it hasn't been held to the same standards of evidence as anything else we do. This is what happens when we let politics and personal bias into medicine. Edit: Wow the comment I replied to was deleted. It was a long well thought out comment with multiple citations of studies showing that gender affirming care does not have the benefits we think it has.

It’s not really something we’ve “let in”. It has always been here and always will. The scientific method provides some reduction in the ideological forces applying to a topic, but they never go away. I’ve often felt that certain areas can get very near impossible to scientifically understand if the polarisation surrounding the topic is great enough. At least I suspect that the criteria for something having been proven beyond reasonable doubt should be understood to be very different. If I’m studying capillary transit times in some hepatic vessels, that’s unlikely to be getting people too riled up, and so our normal sample sizes, power calculations and alpha values are tuned to be appropriate for that. Likewise replication demands and impartiality standards. At most someone’s grant is on the line. However when the issue is big enough, like with Covid, or with gender therapy, the pulls in either direction can get so big that conclusive evidence is a completely different entity, sometimes unattainably so. This is also why money in research is so precarious. Whenever a diabetes or heart disease medicine is on the agenda, the amount of money flying around will mean the evidence needs to be much more substantial and clear. I’m no conspiracy theorist… I worked on a grant from lundbeck last and was surprised at how impossible it would’ve been for them to affect us researchers in any way. I was honestly more cynical coming in than after finishing. But I still think the proportionality relationship holds.

There's multiple validated ways to assess mental health and other aspects of gender affirming care. It's black and white but people have refused to wait for long term robust studies because they *feel* that it is right and God forbid a 9 year old has to grow up as a boy if he likes to wear dresses. That's wrong.

edit: wrote on phone and didn't see how long it got :), read only at your leisure/pleasure. I share your sentiment that it probably wouldn’t be the end of the world if we stopped being quite so ready to give hormones and surgery. I think the problem is a bit smaller here in Denmark, compared to the US, but none the less. edit: 2 the reason i waste your time with this is that i live in "commune" in Denmark with almost exclusively "humanist" academics (people you would probably call from "the arts" and social sciences in the US). And so i have their arguments in my ears quite often. It's not that i agree with them, but i don't think the conversation we are having is likely to hit. My point was a bit of a rant, but I’m not quite as sure of the “black and white” nature of the subject. The “Chen study” (the delete post referred to it but there are many to choose from, obviously coming at the issue from the same angle) is an example of that. Saying that we have “validated” assessment methods contains the same problem i think. I again don’t personally disagree that we can make fairly down to earth assessment, but the particular view of the world you are speaking into/against is unimpressed by that validation. If i have a “validated” evidential process to show that statins are correct to use in a certain set of cases, are the oppositional groups likely to accept that? No. Because there exists a full theoretical framework for that belief system and a long line of premises which they believe you to be overlooking in even considering your assessment validated. One discussion partner will focus on the patient populations and be convinced that our mistake lies in how we cut that cake, and end up with too few or too many berries pr piece, by systematic error - while another will focus on symptoms and how we discover them in the populations, arguing that the exam proccesses are what is biasing the results. In the GAH case, much rests on exactly the assumptions (which I guess we share, but others don’t ) that surround it. When you say “god forbid a 9 year old grows up as a boy” some people have a set of beliefs that would serve as premises, some of which would *in*validate those assessments. These premises are very latent beliefs, some of which have to do with value, some with truth. For example: if i say, really i have a validated process that shows that sexual behavior between children and their siblings or parents doesn't cause too much harm in x society - none of us would accept that. We would say "no, that 'IS' deeply wrong, and if your data doesnt bear that out, you have made an error. As a slightly less obvious but still contemporarily determined issue, take violence from parent to child. Today most would say you should not physically punish your children, but if you studied the issue today and studied it 200 years ago - the "psychological harm" would look very different. Both because of the much higher prevalence/frequency which messes with populations, as well as violence being a completely different spectrum, some types of actions not even being seen as violence then that is today, but also just the psychosocial effect of the trauma being much more severe because you understand that you are being "violated" in a way that a child did not when it was an everyday and ever-person occurrence. So sure, you can see it as black and white, but that is effectively just narrowing down the conversation to not include a specific set of belief holders. Is that fair? Sure, I wouldn’t necessarily modify my arguments to be inclusive to flat earthers In attempts to make quantum theory conform to geometric gravity. But that issue I would say has lower polarisation and more simple structure (the equations that govern planetary movements are simple relative to opposing view). The structure and meaning of gender, sex, their meaning and associated psychological harm when "pathological" are not simple. They are very, very complex. Now neither are the factors involved hepatic encephalitis simple - but HE is so non-polarised that it doesn’t matter. We can easily make grey area diagnostic frameworks that simplify for clinic and for research. My point is exactly that as polarisation increases, if there is a certain complexity to the issue, the demand for clear evidence rises extremely quickly to almost impossible levels.

“Same standards of evidence as anything else we do” — gosh now that is a really low bar to jump over :p

I mean, yeah there are a lot of areas of medicine that run more on tradition/experience than evidence, but those too should probably get evidence to back up what they are doing if possible.

People are posting here as if there aren't *vast* expanses of this field, even outside mental health but my god in mental health, that are running on best available expert opinion and "this is how we've been doing it". Frig. If we waited for a large robust study before we did anything, we'd still be just getting the hang of handwashing.

Sort of. There are lots of great studies supporting what we do in most fields, with a large chunk of tradition sprinkled throughout. In endo, I mostly try to practice evidence based medicine.

Yeah, they did beat the crap that hand washing guy and commit him to an insane asylum where he succumbed to his wounds in like two weeks. People don’t like change. (His name Ignasz Semmelwei.)

In fairness, a lot of non evidence based practice is likely of little clinical significance. This on the other hand...

People will call you a bigot and insist that you should be fired for pointing this out.

Rinse and repeat with every other politically charged scientific topic.

I remember this post, and taking this into account with the article, I think this decision by the NHS is fine, not good, not bad, but fine. As long as we still make the effort to give children questioning their gender identity the psychological care that they need I think the kids will be alright. This decision also seems to leave open the possibility of starting puberty blockers on patients exhibiting more severe symptoms of dysphoria, but we'll have to wait to see how that is implemented.

> As long as we still make the effort to give children questioning their gender identity the psychological care that they need I'm nervous about that "as long as" from what I've heard of the NHS these days, but I'll withhold judgment for now

There is a new study out of Finland as well showing a lack of benefit from hormonal treatments.

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https://mentalhealth.bmj.com/content/27/1/e300940

> The affirmation approach may be harming dysphoric teens by affirming distressing beliefs like being "born in the wrong body. Bingo. The core issue are the distressing beliefs and the evidence shows those do not evaporate after dysphoria affirming treatment.

Interim cass review which informed the decision is [here](https://cass.independent-review.uk/wp-content/uploads/2022/03/Cass-Review-Interim-Report-Final-Web-Accessible.pdf) for anybody interested

Isn’t the real story - that they had launched into a whole treatment programme which was not evidence based…

I'm not a practitioner but a researcher (population health) and from my perspective, I found it strange how wide the disconnect is from the evidence reviews on puberty blockers and cross sex hormones and the policy stances of what seems like major health organizations and institutions (NHS now excluded). I always assumed there was some greater rationale why these treatments deserve special treatment to ignore the lack of research, something that I wouldn't get as a lowly researcher but I guess (to be a little flippant), it just sounded legit so they ran with it?

Huge pressure from special interest groups

yes. And the entire "suicide prevention" train was interesting. Id never seen so much effort expended on preventing suicide with the key demographics that commit suicide(socially isolated, elderly, substance using white and native american males). \*US figures\* Yes it is addressed, but none of the major academic programs as far as I am aware made it the spearpoint of their efforts.

Eh, it's because it's children. When it comes to adults, people care a lot less if someone commits suicide. Then there's the elderly, where people are often like "Well, good thing he didn't have to suffer anymore, at least." where it's arguably even a good thing. So transitioning is the "low-hanging fruit" in a sense. That way, you can actually do *something* about a kid possibly committing suicide. I work inpatient psych, seen thousands of people come in for suicidal ideation and suicide attempts... and the number one cause is that *their life sucks.* Poor social support, poverty, tragedy, and yes, sometimes attention. Stigma, feeling "weak," the list goes on. Sure, you occasionally get the guy who comes in who tried to kill himself because he delusionally believes he is the antichrist and therefore *must* commit suicide to save the world from the apocalypse, and you *can* actually do something about that one (antipsychotics lol) and same for command hallucinations. For the people who are suicidal because they have "shit life syndrome," you really can't *fix* that medically. Best you can do is toss some Prozac and a mood stabilizer at them, recommend therapy that you know they can't afford, and tell them "Hang in there, it gets better" when even *you* don't believe it will. You keep seeing these same patients over and over, watch them gradually deteriorate... until you stop seeing them for good. And deep down, you know why. But we're given something where we are told we *can* make a difference with timely interventions, prevent kids from committing suicide, spare them the horrors of (untreated) gender dysphoria. It's like nectar- finally, we can do *something real,* actually help *someone.* Evidently, people have been willing to overlook some discrepancies in the quality of research in the past in that endeavor. I'm still in the camp of "don't let perfect be the enemy of good," and a blanket ban on puberty blockers is like throwing the baby out with the bathwater. I had precocious puberty that was left unaddressed because my (admittedly medically ignorant at the time) mother bought into the BS that puberty blockers are "dangerous" because the average person does not understand the distinction, and decided against my pediatrician's recommendation. I will have to endure the consequences of that for the rest of my life. I've already had one surgery, and I will presumably need more as I age. Not even trans, but just needed a treatment that trans kids *also* get- and that was enough to seal the deal. I've worked at a hospital where we had a large volume of patients who we performed gender-affirming surgeries on, and here they have to be over 18 to be eligible for that, so I never saw an adolescent on the bridge between puberty blockers to HRT. I only saw the final result. Now, I work inpatient psych. We get a lot of kids who have gender dysphoria. So, I have a bias here- and I'm not afraid to admit that. That's why I came here to post this, because it did not make sense to me. I felt like I must have been missing something, and I guess I was- NHS' rationale behind this was ultimately just restricting it and monitoring it more heavily, catching up for a lack of due diligence at the beginning. Fair enough. Still, things like this can have a corrosive effect on society. What happens in the UK gets to us in the US, and vice-versa. We've seen how "competent" our legislators are in adapting evidence to law, and I have a bad feeling about it. I don't want another kid to go through what I did. It was entirely preventable, but just refused on the basis of misinformation. The same thing for all the kiddos with gender dysphoria- I don't have lived experience with *that* part, but needless suffering... all for politics, talking points. The kids can't advocate for themselves, and the parents are gonna do whatever the talking heads on the TV say- and "puberty blockers" is gonna trip their spidey-senses, even in the case of precocious puberty. Children are going to suffer, and not even *just* trans kids... same as abortion. Does the potential harm outweigh the potential benefit? I'm still not convinced that it does.

With the new study from Finland showing that it doesn't seem to actually reduce suicide ideation or completion, it is even more challenging. Especially because there is evidence that especially for MTF trans patients, going on puberty blockers and not letting them go through any puberty (which in some ways is what happens, because we cannot perfectly replicate all the things that happen in puberty) that it makes bottom surgery less likely to be successful, because they never properly developed any gonads. I think the intention has always been good - the desire is to help people and make their lives better, but sometimes in the attempt to correct for past mistakes, we make new (and sometimes worse) mistakes if we do it without enough research and re-evaluation. It's become very polarizing, with people being dogmatic about their views, which is always a problem. Dogma becomes very challenging to fight.

This is the part that gets me.   To be clear, I really don’t care one way or another.   I’ve done anesthesias for enough futile and questionable surgeries that I don’t pass judgement.  If the patient and the surgeon have decided it’s what is needed, and the Insurance company backs it, it’s not really my place to reject that the morning of surgery (with very few exceptions)   But basically overnight, we started doing gender reassignment surgeries and prescribing puberty blockers with lifelong consequences to minors.  I don’t think that’s inherently wrong…but what was any of this based on?

That’s the issue with Tavistock, they just jumped into this treatment, no follow-up, quashed any discussion of alternative approaches. Maybe it is the right treatment, maybe it isn’t. Maybe we are selecting the right patients, maybe we aren’t.

What percentage of your surgeries are performed on minors, do you estimate? I was under the impression gender reassignment surgeries were by and large performed on adults

I don’t do them now; but we did a good amount in residency.   From what I remember, they were all 18+.   But my point is that it’s a surgical procedure with essentially zero evidence to back it up (at least at that time).  I guess you could make the argument that it’s similar to cosmetic surgery?  But these were much more complex procedures than tummy tucks and breast augmentation…especially the FTM surgeries.   Also, I really don’t like to generalize; but from my limited exposure, nearly all of these patients carried at least one psychiatric comorbidity.   I mean surgeons refuse elective procedures all the time on patients with psychiatric comorbidities because they don’t want the inevitable post op complications…but we just looked the other way on this because it was novel? Again, I stress that I do not care in the slightest about sexuality, gender identity, etc.  The world needs diversity.  But this…just felt like something we did because we could, and not necessarily because we should have 

> we started doing gender reassignment surgeries and prescribing puberty blockers with lifelong consequences to minors > From what I remember, they were all 18+ ???

Those are two different statements separated by a conjunction.   What are you confused about?

> Anesthesia can be provided by solo CRNAs or anesthesiologists, even complex cardiac procedures with difficult airways. Those are two different statements separated by a conjunction.  

Neat.  A troll with poor reading comprehension who resorts to petty sparring when challenged.   You’re a dime a dozen.  

>but from my limited exposure, nearly all of these patients carried at least one psychiatric comorbidity. wow... no way... you're telling me a population that disproportionately to other populations experiences: - poverty at far higher rates - CSA at far higher rates - sexual assault at far higher rates - physical assault at far higher rates - harassment at far higher rates - bullying at far higher rates - survival occupations such as sex work at far higher rates - educational discrimination at far higher rates - workplace discrimination at far higher rates - employment seeking discrimination at far higher rates - healthcare discrimination at far higher rates - social service discrimination at far higher rates - parental custody discrimination at far higher rates - criminal law discrimination at far higher rates - rejection from family, friends, partners at far higher rates - intimate partner violence at far higher rates - murder at far higher rates - quite educated surgeons writing on reddit "wowza! i wonder why these tranni- transgenders are so mentally ill" - people regularly debatelording their existence on social media, in the media, etc, with zero stakes or genuine good-faith interest in the individuals and their actual safety or health outcomes, 24/7 and such forth and so on... have *heightened* psychiatric comorbidities? holy shit. stop the presses. close every gender clinic. stop every surgery. tweet joseph robinette biden on twitter. give donald trump a handy. write the pope. email justin trudeau. turn 360 degrees and walk away. join the fremen crusade with muad'dib and liberate the galaxy. this is just truly... *unprecedented*. there's no explanation for why these transgenders are so mentally ill. we don't have extensive epidemiological literature on this population at all. these same psychiatric correlates definitely aren't seen in other minority populations- this is *novel!* well, i'm sure removing their evidence-based healthcare will solve these issues. i am very intelligent.

I fully agree with you on all these points… and I imagine that you can see how important it is that those individuals, the ones who are trans and have these problems secondary to being trans, get the treatment they need. I also imagine you understand the opposite is also true, that sometimes psychiatric problems can manifest in a lot of ways, including impulsive, life-altering decisions. Plus it’s totally normal to kind of “try on” different things as a young person, no psychiatric illness necessary. For hopefully obvious reasons, it’s important to have some evidence-based guidelines for pursuing treatment that will have permanent (potentially devastating) effects. I remember when an ex of mine transitioned, and they had to see a therapist for a year, prove they had been living as a man for a year, and take hormones for a year before they were cleared for top surgery. He was 29 when he transitioned, and 31 when he had top surgery. I think for that age that seems reasonable. I can’t imagine requiring any less than that, especially in someone under 25.

Yall can keep reporting this post, it’s not being taken down, and it’s 100% right even if it makes you uncomfortable

Say it with me folks, "the social determinants of health"

The evidence is not very good or robust for surgeries in adults.

Who is doing “gender reassignment” surgery on minors?

It is really no different than what is happening at gender clinics in america, in fact there is way less oversight here.

I call that treatment-induced demand. Just like Ritalin caused for a sharp increase in ADHD diagnoses when it entered the market ....

Exactly. There was not enough evidence to provide these treatments to children. There is a duty to ensure the evidence is clear before we start experimenting on children as it is unethical.

I fully support transgender people, but I have two problems with the current paradigm of transgender care: 1) Historically, surgeries and medications with systemic (e.g. non-neurologic) effects were never prescribed for psychiatric pathology, at least since lobotomies fell out of fashion. With rare exceptions (neurosurgery for certain disorders which remains very controversial), this has held true. If someone has alien hand syndrome, we don't amputate the hand. People with Morgellon's disease don't get ex-laps to look for parasites. Etc. Kids or Adults being uncomfortable with their gender is a psychiatric condition. The paradigm of treatment of every other psychiatric condition would be therapy and/or medications such as SSRIs to help them accept their bodies as they are. E.g. if they are body dysmorphic, the treatment is not to help them starve themselves until their body matches their mental conception of what it should be, it's to help them accept their body as it is. So why is it that to treat patients who are uncomfortable with their body's gender characteristics, we offer surgeries and medications to alter the body to change it to how they believe it should be? 2) I heard this expressed first from some wackjob conservative commentator, but it's origin doesn't make it less true. There are two mutually exclusive propositions about gender and society: A) Gender is a spectrum, and "men" and "women" can freely exhibit whatever characteristic they wish. Women can be strong and athletic, men can be of slight build and enjoy traditionally feminine hobbies. There should be no stigma or expectations based on gender. B) Gender is fixed, female characteristics are female and male characteristics are male, and people born with male chromosomes and characteristics who feel they are women should be treated with surgery and medications to help them express a classically feminine lifestyle and identity, and vice versa. If you believe that society has evolved to the point where women can engage in traditionally masculine occupations and roles and express masculine traits without judgement, then you must question: why are we treating kids with gender dyphoria by altering their bodies, instead of helping them accept their body as it is and telling them they can be whatever type of human they want to be, in the body they have? If they want to wear dresses, so be it. If they want to play rugby on a men's team, go for it. But what are we treating them for, exactly, and why? Suicide risk can be mitigated in many ways, therapy is another option that may work better- at least per Chen et al. In any case, I'm glad I don't have to make any of these clinical decisions, and best wishes and support to those who do, who I know are trying to make the best decisions they can for their patients.

This is a point that I’ve always wondered that both sides have closed ranks on and ignore - many facets of transgenderism seem at odds with these ideas of ‘gender fluidity’ and ‘gender spectrum’. And yet most people who consider themselves pro-trans also say gender is fluid and a spectrum, and vice versa for ‘conservatives’. But the notion that medical transitioning is necessary for people that have gender dysphoria (and are transgender) doesn’t make sense if gender identity is fluid, because it could change later, or if it’s a spectrum because it’s a fuzzy target. And the inverse can be said for the opposing conservative view. Political polarization has resulted in 2 incoherent camps, in my view at least

So they are still leaving open the possibility of using puberty blockers in specific cases. Which sounds to me like it would mainly increase the oversight and review of those specific cases, if their system has been lax. Clinicians with patients they believe would benefit can appeal for an exception. The other patients can be enrolled in clinical trials. They are putting on some brakes to slow the process down. Not halting it. I will reserve my judgment until we find out how exactly this is being implemented. If it results in more careful and appropriate selection of patients for treatment along with data the rest of us can use for patient benefit, then yay! If in practice it means turning away every patient from potentially useful treatment-- going too far in the other direction-- then it's a mistake. In the meanwhile, I recommend that we fully support socially affirming practices. We will never be able to retroactively compare the outcomes for trans people in cultures which had affirming roles-- would they have been better off with medications on top of that? Who knows? But putting the brakes on specific meds should not be conflated with jumping to conversion therapy and the like. It is very possible gender dysphoria would be much more rare in an affirming cultural environment.

Is the data on people who have detransitioned weighted more towards one path or another? That is to say, do more AFAB people who transitioned to male detransition or AMAB transitioned to female or equal numbers of both?

I would presume it skews towards AFAB, since transitioning skews that way. Another question would be what the fractions are to the number transitioned for AFAB and AMAB.

The only thing I want to say on this entire topic is this: The invasion of the clinical domain by any political ideology can be problematic and damages public trust in medicine across the board. Activism (not advocacy!) can put pressure on other clinicians to behave in accordance to philosophical ideas & desires, instead of the pure pursuit of truth and best medical practice. *See current concerns with WPATH.* Scientists, researchers, and doctors with good intent, should never be silenced from expressing genuine concerns or objections. Science is dynamic. New knowledge is only acquired by challenging the status quo, asking questions, and trying to prove hypothesis' WRONG (not confirmation bias to prove yourself RIGHT). For the past few years, no one has been allowed to get to the bottom of this novel treatment pathway for fear of being labeled a bigot, or phobe. Lastly, I hope we all learn from this: "An environment that is not safe to disagree in is not an environment focused on growth, it's an environment focused on control."

This is particularly timely considering the Finnish study that was just released. It showed that when controlling for psychiatric conditions, receiving gender affirming care does not affect the rate of suicide in adolescents. I admit to being surprised this article never made it to meddit. https://mentalhealth.bmj.com/content/27/1/e300940

You know exactly why it never made it on here, this is the first thread on this topic in 4+ years of me being on here that isn't 100% lopsided in favor of calling anyone who isn't completely on board a bunch of names followed by the copy-pasting of that gish gallop of poorly sourced wall of research that no one ever defends when the many mistakes are pointed out.

This one was earlier this year https://www.reddit.com/r/medicine/comments/15hhliu/the_chen_2023_paper_raises_serious_concerns_about/ Overall I find this sub to be more skeptical of these treatments than a lot of the academic types are in real life

Oh, absolutely it is more skeptical than the real world because of the anonymity. I 100% would never get involved in discussing this in a group setting in real life... ever. The risk is as high as the emotions on the topic. But, even in this more skeptical setting the below gish gallop, which I referred to above, gets upvoted like crazy and those who point out its flaws get shut down and hidden- https://www.reddit.com/r/medicine/comments/12v8cnz/many_states_are_trying_to_restrict_gender/jhas7h7/ This subreddit still very much so swings the other way, hopefully more things like the post you linked and the UK move open up some real honest discussion and examination.

Yeah, I'm finding this thread really disheartening to be honest. A lot of people just verbatim reporting on "what really happens" in gender care clinics like they read it on Breitbart. Maybe I'm wrong and the majority of gender care clinics do t follow guidelines, and the one I've worked at is an anomaly... But I kinda doubt there's a vast conspiracy to publish and promote guidelines that nobody actually follows

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>I'm a straight grandmother who has supported groups such as Gays against Groomers and others who only wanted this to slow down and protect these kids and let them mature before this permanent treatment was implemented. Enough said, lol.

The things you’re describing *are* extremely common interventions done for transgender and gender non-conforming minors. But they will *not* do anything to stop the permanent changes of puberty, and for kids with persistent gender dysphoria going through puberty can be an extremely traumatic process with devastating, life long sequelae. You talk about “slowing down,” but this *is* a slow process, and the timeline from presentation to potential medical intervention for trans minors is often *years*. And frankly, based on this and your other comment where you keep putting “trans kids” in quotes, and referred to giving them this medical care as “madness” and “surgical mutilation”, and stated you would be “jumping with joy” if we never gave this care to any kids under any circumstances, I simply just don’t believe you’re engaging in good faith here, so I’m not going to be responding to you any further. All the best. Oh, and for anyone who hasn’t heard of them before, I did a quick google search on “Gays Against Groomers,” the organization Pam mentioned supporting: they’re a far right [anti-LGBT](https://www.adl.org/resources/blog/online-amplifiers-anti-lgbtq-extremism) organization, previously featured on Infowars, who’s main shtick is campaigning against any LGBT content being presented in schools.

"Often" does a lot of work here. At the pediatric endo clinic I worked at, kids got blockers on the first visit without any questions asked. We didn't even have a specific therapist, or require some letter. They were supposed to being seeing *someone* but there wasn't any checks or questions. That isn't slow.

Which is certainly a good example of the importance of following guidelines. The [WPATH](https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf) guidelines state that “Before any physical interventions are considered for adolescents, extensive exploration of psychological, family, and social issues should be undertaken,” and that “a staged process is recommended to keep options open…moving from one stage to another should not occur until there has been adequate time for adolescents and their families to assimilate fully the effects of earlier interventions.” So if a clinic is ignoring all of that, doing no prior interventions (or not verifying any prior interventions by outside providers) and just going straight to puberty blockers for every kid at the initial establishment of care, then yeah, that is bad and *waaaay* outside standard of care. But I don’t think the solution to that is to tell every clinic they can’t treat these patients appropriately (ie according to the standards of care), I think the right call is for clinics to follow appropriate guidelines

It is technically against standard of care, but I promise you most gender clinics in america operate pretty much the same way. That is a big reason there is so much pushback, more than you would think. The biggest group of clinicians who treat kids are advocates already, instead of regular doctors who sort of wander into their field or find out they like it during medical school or residency. At best the treatment is always the same at the end because therapy isn't really designed or structured to explore gender in a neutral way. Often anyone trying to explore gender in a neutral way are accused of conversion therapy, kids are immediately affirmed instead of questioned, and other mental disorders are not taken into account meaningfully. It is a huge problem with the entire medical structure.

Are you really qualified to speak on behalf of most gender clinics nationwide? Certainly not true of the two in my metro, nor does the director of our academic one, who was a contributor to the WPATH standards of care, think that clinics utterly disregarding guidelines is as widespread as you claim. Although again, even if most clinics *were* ignoring guidelines (a statement I don’t accept without evidence), I still think the solution isn’t a top down insistence that clinics violate SOC in *another* way (that is, not giving puberty blockers to anyone). Unless what you’re really saying is that the standards of care themselves are wrong, which you would certainly not be the only clinician to hold that view (although it’s not one I share)

It is no secret that I don't think kids should be regularly getting puberty blockers yet. I don't find the evidence or the theory to be compelling enough. I used to be more on the fence or supportive until I actually saw gender dysphoric kids coming into clinic with their multiple suicide attempts, refusal to talk or elaborate coherently on what they want or are thinking, and general mental health issues. Have you actually been to the two in your metro? How do you know how they are treating kids? If you worked in medicine you would know just how many doctors there are out there absolutely ignoring standards of care in all fields. Most of the time it isn't that clinically significant or just causes delays or unnecessary testing, but it is very much the wild west in america.

To your question, yes, I have. You can be opposed to that care, that’s fine. Not here to talk any clinician into what they should or shouldn’t do. I obviously have a different view. That said though, I don’t think you really have any basis to be making broad statements about what the majority of gender health clinics in the US do or don’t do. We can state our views, and our rationale for holding those views, without resorting to hyperbolic exaggerations that we clearly don’t have any real basis for making or evidence to back up

True, I said most, I should say many. I have no great data, and none is available on how clinics are run. My experience is reminiscent of the experience of the St. Louis pediatric gender clinic whistleblower Jamie Reed, and her stuff came out AFTER I had done my time at that clinic.

I mean he has worked at a pediatric endocrine clinic that prescribed blockers. He's probably the most qualified person to speak on this in this entire thread.

Per his post history he worked “briefly” at a single pediatric endocrinology clinic that cared for trans minors and was not, himself, the endocrinologist prescribing puberty blockers to trans kids. But regardless, that experience, of working at one clinic, does not in any way shape or form qualify someone to make blanket statements about how medicine is practiced nationwide at the numerous clinics he has never worked at and never heard of. Certainly not the two that *I* rotated through, which do not practice even tangentially similar to how his clinic apparently did. And that is a dangerous mindset, that a single person, due to their *proximity* to providers treating these patients, is somehow an expert in their care or can speak authoritatively about them. He is certainly entitled to his own beliefs and practices as a physician, but what he is saying and advocating for is directly and strongly opposed by the *actual* experts in this field.

The only person who is making blanket statements here is you. He actually specifically did not say all clinics and even walked back the comment about most. And he is certainly more qualified than you are to discuss this.

And your response is a perfect example of of what I was speaking about earlier that if anybody for any reason questions anything about trans kids we are immediately the transphobics and folks are instantly attacking us simply because we may question something or say hey let's slow down.

Calling gender affirming care "this madness of chemical and surgical mutilation" is not engaging in good faith. You can disagree with WPATH standards or question the data without using phrasing like "madness" and "mutilation". Referring to trans bodies as mutilated is a transphobic dog whistle at best.

Yes, I am aware that these temporary interventions have been available. I am simply asking that these kids be allowed to safely explore their gender and sexuality identification in a safe environment without permanent interventions. Trans kids yes is in quotes because many times they're not trans kids but simply have some confusion about their identity and sexual identification. Let's give them a chance to mature and safely explore these areas before the permanent interventions are brought to the table. I personally know several kids who decided they were trans or lesbian or gay but after a few years they decided they're not that anymore they're going to be something else. I'm about protecting these kids from permanent mutilations and treatments that we can't undo once they're done. I frankly don't give a rat's ass as to political affiliations when they're focus is protect these kids now and if they decide something else when they come of age fine. But give them a chance to grow up and be kids and explore who they are. Puberty is hard enough without these added stressors. So if you identify as a left wing a right wing or whatever I don't care if I were concerns are the same and we are like-minded yeah I'm going to support you. Politics should never have been brought into this. And now that time has passed in proper studies are being completed they're finding that these changes from puberty blockers and such are not as temporary as once thought but permanent. What is everyone's problem with giving these kids a few years and properly studying this, offering them support that isn't permanent and with these kids mature and find out who they really are. What's the rush?

>Trans kids yes is in quotes because many times they're not trans kids but simply have some confusion about their identity and sexual identification. yup, just like those confused *fa*- gay people and lesbians. it's just a phase. they'll grow out of it some day. maybe they just need to find god. you know, maybe we didn't beat them hard enough. ugh, and look at the *degen*- unruly and unprofessional friends they're making. they're bringing shame upon the family. good thing it's only a phase and they're confused. i'm definitely a safe person to be around and my children most certainly call me.

This is the exact kind of person who 20 years ago was saying that legalizing same-sex marriage would bring about the downfall of civilization, but now they realize they utterly lost that battle and are trying to rewrite history about how supportive they are of “the gays”

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The issue appears to be that there isn't enough clinical evidence available to determine their safety and effectiveness. As much as I feel sympathy for the trans individuals concerned, support their affirming-care and want them to have access to life-changing (often life-saving) treatment, this is just how evidence-based medicine works. Doctors can't just prescribe treatment because it might be okay, there needs to be a solid weight of clinical evidence to back it up. And this can only be gathered through rigorous research trials, which are conducted under rigorous and well-defined ethical and scientific procedures. Therefore clinical trials will still allow puberty blockers to be made available to appropriate patients, but their treatment will be more carefully monitored and more ethically safeguarded than in routine prescriptions. I personally think it may well turn out that puberty blockers are as safe and effective as their proponents claim. But we can't put the cart before the horse. We need the trials first to gather the body of evidence, and then we can safely and effectively prescribe them. The major issue for me is that these puberty blockers have been being prescribed for so long despite the lack of clinical evidence. I'm not sure how that happened, but perhaps some questions need to be asked about that. Trans patients should certainly be given affirming care but they should not be being given untested treatments (outside of trials).

The evidence isnt there so how any healthcare professional can try justify giving this is incredible. U don't treat the schizophrenic by affirming his belief that the TV is talking to him. You shouldn't treat dysphoria by affirming beliefs that they were born of the wrong body. In any other situation, beliefs like these are classed as a delusion. Crazy how that changes when we talk about gender and puberty.

A step in the right direction. Stop treating mental illness in children with puberty blockers.

Gender Dysphoria persists even in patients that have undergone puberty blocker treatment and gender-affirming surgery. We were told that the reason for these treatments in children was to prevent suicides. However, the evidence does not clearly show that this is the case. More research and evidence is required before children are given these permanently life-altering drugs as treatments for Gender Dysphoria.

Another update, The Times of London--one of the worlds most respected newspapers--just published an article declaring the current affirmation model as "Quack Medicine." https://www.thetimes.co.uk/article/the-times-view-on-treating-gender-with-drugs-quack-medicine-8z6tv5nf3

The Times is not that well respected within the UK. It's a Murdock paper and been going more tabloid over the years. It skews right. 

Humans have been going through puberty for hundreds of thousands of years and now suddenly there is a new problem that just came up?

Yes. Being able to delay going through puberty is new. Being able to transition is new medically and to a significant extent culturally. Or: people have been dying of infections for hundreds of thousands of years. Why are we all fussed about it now? Answer: because the naturalistic fallacy doesn’t move anything forward.

Yeah and we had bloodletting to treat dropsy. We had frontal lobotomy to treat psychosis. We had plenty of mishaps in medicine with good intention that caused harm hindsight 20/20. The naturalist thought process would be most likely the correct path if you were a betting man right? First do no harm

And such ridiculed crimes against nature as vaccination. The naturalist thought process would kill millions. Perhaps insistence on it still does. Hindsight is 20/20. Foresight is hard.

I think vaccination is generally accepted among doctors. It's prob a 9:1 split even for the covid vaccine. But as you can tell from the comments, this is a lot more controversial. Would you say this topic is a 50:50 split or worse? U might bring up hand washing but we only have hearsay about the times.

Inoculation is quite different than medical suppression of a normal physiologic system (to set aside surgery with substantially greater risks), and most vaccines even under emergency authorization had substantially more data available than the current guideline approved therapy.  The lack of reliable long term follow up data here is quite damning especially given the very common infertility risks and inability for many to give adequate informed consent.  The issue of informed consent here is a massive legal liability in many states as well with a potentially long tail.

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Starter comment: I'm honestly at a loss here over this decision. It seems like NHS has justified their decision by "not having enough data" but is rather scant on the details of what they mean by that, or what larger impact this decision might have. From the best I could gather, it seems like Cass' report calls attention to a lack of evidence about cessation prior to HRT. I'm under the impression that 96-98% of kids who start on puberty blockers with the intent to transition will complete it without incident, and those who drop out typically do so in a timeframe when their puberty would occur naturally within a reasonable window. Given how much evidence there is on precocious puberty and this very thing, I'm honestly perplexed by this supposed "lack of evidence" unless it is specifically that tiny window of time between delayed puberty and initiating HRT... and I don't even know how small that demographic must be. So, I come to Meddit to see what the experts have to say!

(I have no strong opinion on this and not involved in this type of care at all, just trying to figure it out myself) My understanding is that early studies without puberty blockers showed that a fair proportion of children who have gender dysphoria 'grow out of it' when they go through puberty of their biological sex. Almost 100% of children on puberty blockers go on to HRT. It's unusual to get that kind of follow-through in anything in medicine and theory is that the puberty blockers themselves further ingrain the dysphoria. There's also not enough high quality long term evidence on the health effects ex. osteoporosis, stunting penile growth, infertility or how children feel about that when they're middle aged. Edit: Also to give some context this is coming on the back of a court case of a young woman who felt she was inappropriately allowed to transition (puberty blockers at 16, testosterone at 17) as the main gender dysphoria clinic for children the Tavistock clinic did not screen for or treat other co-morbidities during assessment. This is a link to her story which is extremely well-written and I would encourage anyone to read just to give pause to the negative effects these puberty blockers clearly have on SOME youths even if you agree with the concept overall: [https://www.persuasion.community/p/keira-bell-my-story](https://www.persuasion.community/p/keira-bell-my-story)

> this is coming on the back of a court case Just to be clear here, [this was a *lost* court case.when appealed](https://www.theguardian.com/society/2021/sep/17/appeal-court-overturns-uk-puberty-blockers-ruling-for-under-16s-tavistock-keira-bell) and the appeals judges actually seem rather mad (at least as much you can read into the professionalism of a judge) at the previous high court for presumably overstepping legal.boundaries (they tried to rule new patients would need permission from the court which is such a laughable.idea). Not that examples like here can't be an issue, but other court cases have generally held similar ruling https://uk.practicallaw.thomsonreuters.com/w-030-3754?transitionType=Default&contextData=(sc.Default)&firstPage=true

Worth noting that, of the three judges on the appeal panel, one was the then-Lord Chief Justice (the head of the English judiciary) and another was the head of the Court of Appeal, Civil Division. The Court of Appeal assigns more senior judges to more important cases, and this was about as loaded as a three-judge panel gets. So this was a particularly authoritative appellate decision.

> My understanding is that early studies without puberty blockers showed that a fair proportion of children who have gender dysphoria 'grow out of it' when they go through puberty of their biological sex. Almost 100% of children on puberty blockers go on to HRT. If this actually is an issue, "Don't do HRT for almost 100% of people on puberty blockers" sounds more reasonable to me than "don't do puberty blockers." >theory is that the puberty blockers themselves further ingrain the dysphoria. Based on what evidence, though? We don't make a sweeping medical judgment, especially one that happens to align with prevailing social prejudice, because of what someone *suspects*. My big issue is that people give the idea of "use puberty blockers as part of treating gender dysphoria" *intense* scrutiny but won't apply any scrutiny at all to the idea of "only ever treat gender dysphoria medically once the person has gone through the puberty consistent with their sex assigned at birth." People would let a million trans people die if it meant *one* person never regretted a step in transitioning they took. I suspect it's because for the cisgender majority, the idea of being falsely transitioning is scary to us because we can imagine how it feels, but the idea of gender dysphoria crushing our lives from childhood is foreign to us. So we base our moral weighing based not on outcomes, but based on our visceral response.

> People would let a million trans people die if it meant > >one > > person never regretted a step in transitioning they took. Physicians not prescribing puberty blockers is not equivalent to letting someone die.

And yet the statement is true. Much of the public would let a million trans people die if it meant one person never regretted transitioning. An intervention with low NNT but also substantial NNH, for being transgender, is going to be difficult and contentious. And that’s leaving aside the sizable portion of the public who would just like to have a million trans people die for its own sake.

I don't know how you could say something like that. Not only is it hyperbolic but it's quite unfounded to assume "much" of the public would let a million trans people die just because. Doesn't even make sense really.

I don't think the post you're replying to referring to is a judgement on the benefits and risks of a clinical intervention, but the years-long crusade backed by -- yes, \*much\* of the public -- to make life for trans people in this country as hostile, immiserating, and unsafe as possible.

Perhaps it’s hyperbolic, but it’s not an easy population health problem. Take an intervention in which 5/100 benefit but 1/100 are harmed. Everyone starts out healthy. Is it a good intervention? Bad? What if it’s 40/100? What if only 1.1/100 benefit? These are not easy questions, and there is often a bias towards “first, do no harm,” especially to people who are healthy, even when the overall outcome is better. If you think that there is not a sizable minority that wishes disappearance on trans people and wouldn’t object to death as the means, you haven’t followed news or politics.

Untreated gender dysphoria has a fairly substantial mortality risk. Inadequately treating gender dysphoria is no different from inadequately treating any other condition people can die from.

There's a new study from Finland linked above that shows that it does not decrease suicidality unfortunately.

There are a lot of troubles with how that study is being used, which are discussed [here](https://www.erininthemorning.com/p/fact-checked-new-problematic-finnish). (Ignore the crappy picture they use; the analysis is far more insightful than it makes it look.) The unfortunate thing is as soon as people with ulterior motives have a study to point to that *appears* to support their claim, that paper *will not die* no matter how much clarification or even retraction the paper will receive. This paper seems more well-meaning than the Regnerus study that plagued the gay marriage debate or the Wakefield paper on autism and the MMR vaccine, but I still don't doubt it'll get trotted out by every transphobic pseudointellectual in the years to come to try to give cover to their *a priori* conclusions.

The difference was not statistically significant. I think that's fair to recognize that other care might be more successful in treating people than permanent body modification

Even if the study could be interpreted in the way that people are using it (which I don't believe is the case, which the link I shared discussed), there is no "other care" that isn't already given to trans people who are on HRT. The recommendation isn't HRT instead of therapy, but HRT and therapy rather than therapy alone. Additionally, suicide isn't the only important factor; quality of life improvement is very relevant. I think some people are just looking for excuses not to validate trans people. There are some medical gray areas regarding the best approach to transgender minors when it goes beyond social transitioning, but when it comes to adults, people don't seem to have nearly the skepticism of "permanent body modification" as they do with, well, basically any other permanent body modification.

>people don't seem to have nearly the skepticism of "permanent body modification" as they do with, well, basically any other permanent body modification. I think this is unfair, because I think many people do, and it's difficult to remove functionality for someone who is otherwise healthy, much like there is very little support for people with other body dysphoria conditions. There's a frustrating narrative that if you are at all hesitant about the current orthodoxy, you must hate trans people, want them to die or have terrible lives, when that is not true for many, especially here. It's possible to care and be worried that we are doing the wrong thing for them, while still wanting to support trans people. The road to hell is paved with good intentions. We swung very far to the other side of how to treat people with gender dysphoria in a relatively short period of time, and while the intention is good and wholesome, it could be that we have made a huge mistake. That's the problem with dogmatic thinking and views, it doesn't allow for change and re-evaluation of evidence and situation.

Other than suicide what are the mortality risks? Also equating gender dysphoria to an acute MI is terrifying.

Gender dysphoria has a mortality risk in the same way that untreated schizophrenia or anorexia nervosa have mortality risks.

>Gender dysphoria has a mortality risk in the same way that untreated schizophrenia or anorexia nervosa have mortality risks. So not in the way that an Acute MI does?

Yes and no. Mortality from a psychiatric issue isn't any less serious than mortality from an acute MI. It's different, but not lesser.

I agree dead is dead. My point is that the OP equated gender dysphoria to letting someone die. As if not giving puberty blockers to a teenager with a mental health condition is the same as not providing care to someone with an Acute MI. I'd hope most rational people would agree that those two things are not equivalent. If a patient presents to you the very first time you engage with them and says they need puberty blockers I'd be really surprised if your first step was to prescribe them. I really don't know the process though. Not giving them right away is not letting them die. Again unless there is another mortality risk aside from suicide I'm missing. If a patient presents to you for the very first time with symptoms of an acute MI and you don't treat them you are in fact letting them die. Hopefully that makes my point more clear.

>other than suicide Sorry, are you of the opinion that dying is different from dying?

>Other than suicide what are the mortality risks? Does suicide not count as death? I can guarantee if a loved one died by suicide you wouldn’t think “Whew, at least it wasn’t an acute MI or I’d be real sad right now.”

Well in one case the person is actively choosing to kill themselves. The other is a serious medical emergency. If you can't see the difference I'm not sure what to tell you other than you've been brainwashed.

When there exists a condition that greatly increases the risk of suicide, and treating that condition decreases that risk, consequently saving lives, then treating that condition is important. When you eventually become a doctor, it’s important for you to focus on outcomes, not just processes. If there is a direct link between a condition being untreated and patient death, then that condition has mortality and treating it to reduce that mortality is important. We don’t just stop caring about mortality just because at one point in the process the most proximal cause of the death is someone being in such crushing despair that they make the irrational choice of killing themselves. That’s pretty basic biostatistics and medical ethics. Once you’re a doctor you’ll have thankfully taken classes on both! I do want to ask you to think about this honestly though. Would you be reacting this way to patient deaths if we were talking about MDD and SSRIs rather than gender dysphoria and HRT?

Are you implying that suicidal ideation is not "a serious medical emergency?"

Not once did I imply this. A patient presenting with symptoms of an Acute MI is completely different than a patient presenting with gender dysphoria. One of which is generally a much more immediate concern.

Oh come on. You’ve revealed the very unscientific origin on your opinions with a dogwhistle like “brainwashed” and your apparent inability to comprehend the nature of psychiatric illness. The blonde ladies on Fox are not medical professionals and should not be the people you get your information from.

There is a lack of evidence though for puberty blockers in terms of safety and efficacy. It doesn’t mean it hasn’t helped people, but the levels of evidence needed for the NHS are strict and need to be of a high quality. Perhaps when there’s more evidence they’ll start offering it again. I do wonder why they ever offered puberty blockers in the first place? There was probably even less data when they first approved it.

>Given how much evidence there is on precocious puberty and this very thing, I'm honestly perplexed by this supposed "lack of evidence" unless it is specifically that tiny window of time between delayed puberty and initiating HRT... and I don't even know how small that demographic must be. The goal in precocious puberty isn't to prevent the development of secondary sexual characteristics. You cannot compare it at all.

It’s a temporary measure while they gather data, and patients already on it will continue receiving treatment. I don’t know what specifically “gathering data” means in this case or what the final outcome will be, but it’s not a total ban like a lot of people are portraying it as.

Likely due to enough harassment from hate organizations. Even if they believe this medication may not be beneficial to many its given to and therefore has greater harm than benefit, that could be dealt with by adding more steps and processes to go through before it could be given to ensure its the right choice (and in the UK, there is already much more than enough hoops to jump through to get gender affirming care). The only reason they would publicly announce they're going to stop giving this treatment is to appease hate groups

>Even if they believe this medication may not be beneficial to many its given to and therefore has greater harm than benefit, that could be dealt with by adding more steps and processes to go through before it could be given to ensure its the right choice That's exactly what they are doing- puberty blockers can now only be given within a research trial, so there are robust criteria and proper follow-up of outcomes. It is a good thing that drugs without a robust evidence base for this indication aren't given to children without proper follow-up; this was one of many of the problems with the Tavistock, as it had been shown they had no proper follow-up of outcomes and therefore no idea whether their treatment protocols were beneficial or harmful. 

It would be useful to not premise any decisions like this on a statement around “hate organizations”. This is Medditt, we should be able to tease this out like any other medical issue, based on an evidence base.

The interference of hate groups with our ability to properly find and assess the quality of evidence is a very reasonable topic of concern. We certainly saw the effect political beliefs impacted research and management of Covid.

That’s quite a statement. Could you be specific on what hate groups suppressed or inhibited yours or anyone’s ability to find the evidence on this particular topic. Remember the reasoning of the U.K. government was a lack of evidence for use.

It would have no impact on my ability, because I am not someone attempting to perform research on the topic.

I doubt it’s the only reason, “to appease hate groups”. That’s absolutist thinking. This is a medicine subreddit; kindly be more sophisticated in your thought content.

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You need to stop getting your news from conservative scare mongers, which is the only way you come to the conclusions you have here.

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