Bigmouth Strikes Again: Carrie Marshall's blog

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Category: Health

Scare stories and newspaper nonsense

  • Inconvenient truth

    One of the hallmarks of the genital-obsessed weirdo movement is to claim that there’s not enough research about trans healthcare, and to then ignore any research about trans healthcare because it doesn’t support their lurid claims. And there’s a great example of that in Utah where the Republicans commissioned a Cass-style report to justify their ban on trans healthcare but forgot to put a bigot in charge.

    The result? The evidence shows that trans healthcare is effective and safe and that bans cause great harm.

    It’s very detailed – much more so than the Cass Review – and as The Advocate reports:

    “The conventional wisdom among non-experts has long been that there are limited data on the use of [gender-affirming hormone therapy] in pediatric patients,” the researchers wrote. “However, results from our exhaustive literature searches have led us to the opposite conclusion.” The study found over 230 primary studies involving 28,056 trans youth — “far exceeding” the evidence that typically supports FDA approval for high-risk pediatric treatments, including gene therapy.

    “The body of evidence we have uncovered exceeds the amount of evidence that often serves as the basis of FDA approval for many high-risk, new drugs approved in pediatric populations in the U.S.,” the authors added.

    The report emphasized that such treatments are not given to prepubertal children, that puberty blockers and hormones are typically initiated only in early or mid-adolescence, and that surgeries — especially bottom surgeries — are not recommended for minors. The review also found no significant long-term safety concerns, and that “regret” associated with treatment is extremely rare. In fact, among the 32 studies examining regret, researchers found it was “virtually nonexistent” — and when present, it was “only a very minor proportion” of treatment discontinuation.

    The response, from politicians and national press alike, has been to ignore it.

    As I’ve written before, the problem isn’t that we don’t have evidence. It’s that the evidence doesn’t say what the genital-obsessed weirdos want it to say, so they discount it, distort it or ignore it. They’re not interested in the truth. They just want to hurt trans people.

  • Don’t get sick. Don’t get old

    One of the things that really scares me is getting old – not because I’m scared of ageing, but because unless I die first I’ll eventually need to enter the care system. The care system in the UK is horrific for most, and there are extra terrors for LGBTQ+ people – so much so that many UK care homes believe they have no LGBTQ+ residents, as those residents have chosen not to reveal their sexuality or gender history for fear of discrimination or worse.

    Writing in Yorkshire Bylines, Nell Stockton explains the additional fears caused by the anti-trans Supreme Court verdict and subsequent EHRC misinformation.

    The short version: it’s an absolute shitshow that could do serious damage to older trans people’s lives, their health and their safety.

    All of us will hopefully get to live to a ripe old age. Trans older adults deserve to enjoy their later years as much as anyone, without fear of being outed and shunned, and we should not be forced into becoming recluses.

  • Cass, peer reviewed

    A new peer review of the Cass report yet again shows that it was a political exercise designed to rubber-stamp the government’s war on trans people and our healthcare. The report’s conclusion is damning:

    Our critical analysis reveals significant methodological problems in the commissioned systematic reviews and primary research that undermine the validity of the Cass report’s recommendations. During our review of the report and supplementary primary research, we found insufficient statistical rigor, unreliable datasets, claims presented without evidence, and misrepresentation of quotes from primary research participants.

    Cass should have been struck off for this. Instead, she was given a peerage.

  • Basic biology

    The bigots are furious with doctors who dare to challenge their primary school-level understanding of human biology. Resident doctors of the British Medical Association approved a motion yesterday that called the Supreme Court verdict – which repeatedly used the term “biological women” but seemed unable to say what that actually meant – “scientifically illiterate” and “biologically nonsensical”.

    The anti-trans groups have of course lied about what the motion said, claiming that doctors said there was “no basis” for biological sex. But that’s not what the text said. It said:

    We recognise as doctors that sex and gender are complex and multifaceted aspects of the human condition and attempting to impose a rigid binary has no basis in science or medicine while being actively harmful to transgender and gender diverse people.

  • The Brexit of healthcare

    Another day, another demonstration that the Cass report into puberty blockers was a political move, not a medical one.

    As the epidemiologist and writer known as Health Nerd posted to Bluesky, “The BMJ journal Archive of Disease in Childhood has just published the epidemiological study done by York university that was commissioned as part of the Cass review into gender clinics in the UK. It contains some startling (and yet, unsurprising) revelations… this report undermines most if not all of the Cass review recommendations regarding clinical care.”

    The study found that gender dysphoria diagnoses were incredibly uncommon; that a tiny proportion of those studied were prescribed any medication; and rates of prescribing were falling, not rising.

    Elsewhere, solid criticisms of the Cass report continue to be published. This piece in the Journal of Paediatrics and Child Health describes it as the Brexit of health care and notes that “it is very unusual in the history of medicine that a time-honoured treatment, with a good safety record, even if based on non-randomised trials and experts’ opinion, is simply banned”.

    You can find a very comprehensive collection of links to Cass-related studies and commentary on Ruth Pearce’s website here.

  • A broken system

    Abigail Thorn, actor and writer of Philosophy Tube, posted a video two years ago about her (awful) experiences of the NHS. The short version: she demonstrated how the NHS is institutionally discriminatory towards trans people. So I imagine she was quite surprised when a very senior NHS figure approached her about being the face of a new campaign about changes in NHS trans provision.

    Thorn said no, and has written an article explaining why. Thorn is the first to say that there are some very good people working in the NHS, and in trans care specifically. But the organisation itself is broken, and treats trans people appallingly. And it’s getting worse.

    I’m writing this in my sixth month of having my basic healthcare refused by my GP, healthcare that the GP happily provides to dozens of cisgender people but which is apparently too difficult to provide to me. I’m a few months away from finally getting surgery I first asked to be referred for six years ago, a referral that was never made because the gender clinic doctor simply didn’t bother doing it, a mistake or deliberate omission that I didn’t find out about for two years. My next referral was delayed because the gender clinic made an appointment for the mandatory second opinion, never told me about the appointment, and then concluded that I had changed my mind about wanting referred because I didn’t attend. Another year gone.

    So it’s fair to say I’m sympathetic to Thorn’s argument.

    There are many problems with NHS care for trans people, and they’re about to get worse with a Cass-style stitch-up labelled as a review of adult care. That review isn’t going to recommend that the NHS does something about the infiltration of conversion therapists, or the humiliating assessments we have to go through, or the woeful lack of staff, or the waiting lists that mean many trans people will die before even having a first assessment. And it’s not going to do anything about making trans people’s access to care any easier, because as Thorn points out:

    every single person I have spoken to in the NHS- from local GPs to the National bosses- told me they are powerless. There is nobody at any level of the organisation who takes responsibility for the state the service is in and the suffering it is causing. Every single person blames the person above them, even the man at the top.

    …I agree with others who study this field that consultations and “stakeholder meetings” have become a form of abuse by the NHS and the government: we’re included nonperformatively – given time to speak in order to legitimise the process of ignoring us.

    In years to come, this will rightly be viewed as a scandal. But it’s going to harm many more people before that happens.

  • Sadistic pencil-pushers

    There’s a superb piece in Dazed by Sasha Baker, who explains how a vocal minority of religious and social conservatives has managed to dismantle trans healthcare and human rights in the UK without a single law being passed or revoked.

    The British gender critical movement purports to represent a silent majority, but knows it does not command enough support to publicly shred the documents guaranteeing our rights. Instead it has adopted the methods of sadistic pencil-pushers – its true constituency – burying human rights laws in reams of secondary legislation, statutory and non-statutory guidance, grey literature, and fudged equality impact assessments.

    As the article notes, a key part of that is the Cass scandal: a supposedly clinical review that was created and staffed in order to achieve a pre-determined political outcome, and which – despite repeated claims to the contrary in the press – found no evidence whatsoever that puberty blockers are dangerous or that their use should be curtailed.

    You’ll read a lot about “evidence” in connection with the Cass scandal. Here’s one of the crucial bits of so-called evidence on which Cass leaned heavily.

    In February, Sallie Baxendale, a psychologist, published a terrible academic paper that claimed to look at existing studies on the negative effects of puberty blockers on trans children’s cognition. In reality, most studies surveyed were performed on animals, with only one case study showing that a single trans child scored lower on an IQ test after taking puberty blockers… it was rejected by three journals and met with scathing comments from peer reviewers [but] Dr Hilary Cass chose to cite it four times in her final report, and determined that puberty blockers should not be prescribed to trans kids outside of an upcoming clinical trial, in part because of “potential risks to neurocognitive development”.

    What we’re seeing on a frankly frightening scale is the very opposite of evidence-based policy; the policies are decided first, and the evidence cherry-picked, distorted or manufactured to support them. This will not end with us.

  • Stacking the deck

    Yesterday, Wes Streeting made the UK ban on puberty blockers for trans kids permanent. The ban does not apply to cisgender children; puberty blockers are apparently magic medicine that are uniquely dangerous to trans and gender non-conforming kids.

    The decision was subject to a consultation, which – at the Government’s invitation – featured significant input from anti-trans, pro-conversion therapy organisations with no expertise in healthcare generally or trans healthcare specifically. And despite blatantly stacking the deck with those anti-trans groups, the consultation could still not produce evidence to justify the ban. It did, however, make it clear that the ban would have terrible effects on trans kids’ mental health. We’ve already seen more than a dozen children take their own lives as a result of the temporary ban.

    Streeting simply ignored the evidence and imposed the ideologically motivated ban on the UK, including Scotland. Pressure from the UK government ensured a similar ban was passed in Northern Ireland with the support of Sinn Fein. There’s bleak humour in seeing UK Labour and Sinn Fein finding common ground in killing children.

    I’ve long since given up on trying to get people to care about trans people. But an evangelical government minister banning medically necessary healthcare by prioritising the thinky thoughts of newspaper columnists and religious and social conservatives over evidence and international medical consensus is a terrifying precedent for everybody.

  • Fancy that

    The UK isn’t the only country where there have been reviews into the effectiveness and safety of puberty blockers. And it’s interesting to see what such reviews conclude when they’re not created to deliver, and staffed by people promised a peerage if they deliver, a pre-determined conclusion to support a political goal.

    The latest such study comes from France. Unlike the UK Cass Review, which decided that having medical specialists involved in a review of medicine would be biased, the French study was carried out exclusively by pediatric endocrinologists.

    Regarding puberty blockers, it notes that:

    None of the medical treatment used in the context of hormonal transitioning have marketing authorization for this indication, but these molecules have been used for a long time in the pediatric population for other indications (precocious puberty, puberty induction…). Nevertheless, they have been used for hormonal transition in trans youth since the late 1980s in some countries, and their use in adults goes back even further. In addition, off-label prescription is very common in pediatrics and child psychiatry.

    And based on the evidence, it recommends:

    We recommend that puberty suppression be offered by a multidisciplinary team or network trained in supporting transgender adolescents.

    In related news, a new scientific study funded by the IOC and published in the peer-reviewed British Journal of Sports Medicine demonstrates yet again that trans women do not necessarily have physical advantages over cisgender women in sports; in many cases, they have significant disadvantages in lower body strength and in lung function.

    I’m sure our trans-obsessed media will cover that story, and the French study, any day now.

  • Enemies within

    The evangelical movement has spent a very long time practicing institutional capture, where it inserts its people into positions where they can enact its policies. And the same appears to be happening with the anti-trans movement here in the UK, with “gender-critical” people who reject the scientific and medical evidence increasingly inhaibiting positions where they can influence healthcare and health policy.

    The latest example, as reported by Novara Media:

    Six leading gender clinicians associated with a controversial NHS review of transgender healthcare spoke at the conference of a designated anti-trans hate group that shares funding with key pro-Trump outfits

    They weren’t there to defend trans healthcare.

    Two of those people were involved in the ideologically motivated and widely discredited Cass Review, which has been used to stop healthcare for trans teens and which is being widely cited by people who want to stop trans adults’ healthcare too. A third is cited in that review and also sits on the board of the anti-trans pressure group SEGM, known as one of the “key hubs of anti-LGBTQ+ pseudoscience”.

    SEGM, for example, takes money (via the Edward Charles Foundation) from the Charles Koch Institute, a conservative political network that also funds the Heritage Foundation. The Heritage Foundation is the group behind Project 2025, a 900-page “wish list” to centralise presidential power and normalise religious conservatism, including by tightly restricting abortion access and expanding political appointees.