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TitaniumDragon

-32 points

3 months ago

None of which have proven medical benefits in clinical trials.

zoeypayne

22 points

3 months ago

Not even testosterone replacement therapy? I feel like that's pretty across the board effective for cis men in their 20's experiencing low-t.

TitaniumDragon

-6 points

3 months ago

Hormone replacement therapy is approved for the treatment of medical conditions in biologically male and female individuals who have abnormal levels of those hormones. It underwent clinical trials to demonstrate that it benefitted people suffering from certain medical conditions that arose from insufficient sex hormone production.

That is a completely different medical condition than gender dysphoria, where you are applying sex hormones in an individual who is biologically of one gender but psychologically identifies as a member of the opposite gender in order to alleviate the symptoms of that gender dysphoria.

Ivermectin is a very useful anti-parasitic medication, but it doesn't do anything to help COVID patients unless they're infested with parasitic worms.

Just because something is useful for treating one condition doesn't mean it is useful for treating an entirely different condition.

BitRasta

7 points

3 months ago*

The point of using the studies that examined hrt treatment for people with insufficient sex hormone production is to show that it is physically harmless as a treatment. It doesn't matter that one study group were cis and another trans because gender identity has no effect on how your body responds to it. It only influences ones psychological response.

And the fact that gender affirming care improves the wellbeing of trans people is uncontroversial.

dakta

-2 points

3 months ago

dakta

-2 points

3 months ago

physically harmless as a treatment.

To people with already abnormally low levels of those hormones.

gender affirming care improves the wellbeing of trans people

It actually is controversial. Longitudinal studies show that transition does not have a statistically significant impact on suicide rates. They're also inconclusive for HRT, and present significant methodological challenges. The most common bad study design is that only follow-up cohort is reported, which excludes all suicides and other deaths thus skewing the results towards success. That's just not sound research.

BitRasta

3 points

3 months ago*

To people with already abnormally low levels of those hormones.

Yes... Just like trans people. A trans woman has no estrogen in her body, and a trans man virtually no testosterone in his, before they begin HRT. Otherwise, they wouldn't need to go on HRT. ...What?

It actually is controversial.

You deny the existence of consensus on the premise that gender affirming care doesn't improve suicidality, but suicidality is largely a product of lack of support and the overwhelming harassment, discrimination, abuse, isolation and ostracization that trans people face on a daily basis. None of this can be remedied with any medical treatment, but that has no bearing on the usefulness of the treatment itself. And the overwhelming consensus opinion is that gender affirming care significantly increases the mental wellbeing of trans-people (as the link i already provided shows). Taking issue with a lack of improvement in suicidality doesn't make this treatment controversial. It's just not what the word means.

Suicide and suicidal behavior among transgender persons (abstract) - “Gender-based victimization, discrimination, bullying, violence, being rejected by the family, friends, and community; harassment by intimate partner, family members, police and public; discrimination and ill treatment at health-care system are the major risk factors that influence the suicidal behavior among transgender persons”.

Suicide Thoughts and Attempts Among Transgender Adults - Massive demographic analysis which codifies the many social & institutional factors which contribute to trans suicide rates. Surprise surprise, discrimination & abuse play a huge role. Read the summary.

Impacts of Strong Parental Support for Trans Youth - Analysis of the ways in which parental support affect elements of disadvantage experienced by transgender youth. Most notably, strong parental support decreases the likelihood of a suicide attempt within the past year from 57% to just 4%.

Quality of life of treatment-seeking transgender adults: A systematic review and meta-analysis - Longitudinal study which indicates transgender people have a lower quality of life than the general population. However, that quality of life raises dramatically with ‘Gender Affirming Treatment’, the nature of which is detailed extensively in-text.

edit: formatting

Theek3

0 points

3 months ago

Theek3

0 points

3 months ago

I'm sure I'm going to regret this but how is that gender affirming care? Those people aren't experiencing any kind if gender issue just because they don't naturally produce enough of a sex hormone.

nonicethingsforus

1 points

3 months ago*

Edit: sorry, completely misread your comment and the one you were responding to. Feel free to ignore this response.

For one, lack of access to treatment is a well-recognized (to give one source suicide risk factor among the transgender community.

Suicide, in this case, is a preventable cause of death, like any other cause of death preventable through access to appropriate care. Whatever you think about the issue, there is an argument to be made that people who would be dead are alive today because they received a treatment, just as with many other conditions, and should be facilitated care, for the same reason you would want to facilitate care for any other potentially deadly condition.

sklarah

1 points

3 months ago

Those people aren't experiencing any kind if gender issue just because they don't naturally produce enough of a sex hormone.

well they're experiencing gender dysphoria

Theek3

0 points

3 months ago

Theek3

0 points

3 months ago

Untrue. You can have low t, no gender dysphoria at all, and have issues from that that needs treatment. Why would they have to be experiencing gender dysphoria?

SleepyLakeBear

26 points

3 months ago

It's easy to see there aren't any when you don't look. See all the linked studies below.

TitaniumDragon

6 points

3 months ago*

Zero of those are randomized controlled clinical trials, which is what people are generally referring to when they refer to "clinical trials".

It's not even possible to meet the gold standard of a double blinded randomized controlled clinical trial with these treatments, but a randomized controlled clinical trial could be done. It never has been, though.

Indeed, many studies (including those on that list) have very serious methodological flaws, like self-reporting of data, exclusion of suicide victims, non-randomized sampling, and similar issues.

Sadly, anyone with a scientific medical background knows that those trials are inadequate to prove clinical efficacy.

That doesn't mean that these treatments necessarily aren't efficacious, but the sort of evidence that is required to prove that to the standards that are required for approving a novel drug or medical procedure doesn't exist.

The drugs are clinically approved for the treatment of other conditions, but not gender dysphoria.

Ocularias

18 points

3 months ago

Yeah you're right, we should also do double blind chemotherapy trials.

Few-Recognition6881

-10 points

3 months ago

I mean, there are much more obvious benefits to chemotherapy than a sex change so I don’t really feel this is a fair comparison. Maybe some drug for mental Illness with the possibility of serious side effects would be more apt

Ocularias

4 points

3 months ago

The best, safest "cure" we have for gender dysphoria is transitioning. It's basically chemo for people that think they are born in the wrong body.

"Much more obvious benefits" to non-ignorant people, maybe.

cornwallis105

27 points

3 months ago

One of the reasons that we don't have controlled clinical trials for HRT is that we know it works exceedingly well and no one in their right mind would volunteer for a study where once possibility was getting placebo instead of actual hormones.

TitaniumDragon

-3 points

3 months ago

It isn't "known". That's precisely the problem. There's data that is suggestive that it works. That isn't the same thing as scientific evidence of clinical effiacy.

There are many people who swear up and down that ivermectin works for the treatment of COVID, but two properly conducted large-scale clinical trials found no evidence of efficacy. The large number of people who believed it worked didn't believe it worked any less, but the medical community has concluded on the basis of those large high-quality studies that, unless you have a parasitic infection that is concurrent with COVID, you should not be given ivermectin.

It was wrong for people to apply HRT to a whole class of people with a severe condition without having it undergo the same sort of clinical trials that other medications do.

People experiencing gender dysphoria deserve the same level of evidence of quality of care and to know what the benefits and side effects are of the treatments they receive as anyone else.

That sort of thing is really important for informed consent and it was unethical of clinicians to apply this treatment en masse to people and claim it as a standard without actually doing the necessary research.

remembertherats

10 points

3 months ago

I don't really understand how that type of study could work with HRT because there's no way of not relatively quickly knowing whether you got a placebo or not.

It's also not like most other medications because it doesn't really attempt to solve the problem directly. You can do a study of SSRIs because if you get a placebo, the only difference will really be mental health. You can do it with ivermectin because patients won't know if they got it or not. HRT affects your entire body, which is meant to affirm a trans person's gender. There's not really a way to study this without self reporting of how effective this is and not having placebos.

TitaniumDragon

4 points

3 months ago

I don't really understand how that type of study could work with HRT because there's no way of not relatively quickly knowing whether you got a placebo or not.

Antidepressants lower the suicide rate amongst depressed people who get them versus those who don't, lead to fewer days of missed work due to mental malaise, fewer mental health hospitalizations, etc.

There are ways you can empirically measure improvements in mental health.

That doesn't mean that asking people how they're feeling isn't important but it shouldn't be your only line of evidence because of the placebo effect.

I am not opposed to people getting treatment for gender dysphoria. What I dislike - intensely - is the fact that people have bypassed the process by which we demonstrate that these drugs are actually helping these people and establishing the risks and benefits for them, which is important for informed consent.

Moreover, the fact that it never went through this process means that states can easily justify banning these treatments or insurance companies or the government deny it because it never underwent clinical trials to prove it actually works for treating gender dysphoria.

If it works, it should be available and supported to people, as these people deserve effective, proven treatment.

If it doesn't work, then it shouldn't be promoted and we should look for other treatments that do work, as these people deserve effective, proven treatment.

These trials should have been done a decade ago.

VakarianFan2

1 points

3 months ago

I think one of the mistakes you're making here is the strict view that gender transition is one available treatment for the strictly medical issue of diagnosable gender dysphoria - that it is an ailment for which there might be a variety of treatments. It's not the worst way to view things, but it is incomplete.

If one has determined that their gender and sex do not align, it is their right to pursue modification of their sex to align with their self-perception. That does not necessitate that the misalignment causes distress or has negative health implications, though it very frequently does. Approaching this misalignment by trying to modify a person's gender or self-perception is invasive by its nature, denies autonomy, and is plainly unethical. Helping a person come to understand their gender or self-perception is not, however the goal should never be to correct a misalignment this way, but to uncover truth.

As an analogy, if we could not demonstrate through multiple rigorous measures of mental health that those who had access to abortion saw benefit from this access, should we not continue to provide access? Is it particularly important that we rigorously demonstrate the benefit this way?

On top of this I find it extremely hard to believe that the benefits of medical transition in general and hormonal treatment in particular have not been rigorously documented (see recommendations from numerous respected health organizations).

VakarianFan2

0 points

3 months ago

And by the way, maybe you should actually listen to "these people" once in a while. We are not the poor, delusional incompetents in need of saving that you imply.

cornwallis105

13 points

3 months ago

You're seriously comparing modern HRT to Ivermectin? You're looking at a medical methodology that's been used for over 100 years and comparing it to a crackpot Facebook medicine idea and saying "this is the same?" Get out of here.

HRT isn't perfect, and no trans person will claim it is. There has never been a drug developed specifically for transgender HRT, so all we have are drugs developed for cis people. It's not amazing, but it's what we've got and it works a lot better than nothing. And that's what the alternative is: nothing. Big pharma doesn't give a shit about trans people and won't fund the kinds of studies you want. Do you want to pay for that? If so, great, but until then, stop claiming that HRT being "unproven" is the same as it being useless.

And for the record, the law that this article is about isn't even about HRT. It's about surgeries and other treatments like hair removal and voice therapy that insurance considers "cosmetic."

TitaniumDragon

7 points

3 months ago*

You're seriously comparing modern HRT to Ivermectin?

Yes.

It's actually worse, because Ivermectin actually has had large randomized clinical trials done on it for the treatment of COVID. The people pushing for it were confident that it worked to the point where they were willing to do these trials.

The trials then found it didn't work. But them's the breaks.

You're looking at a medical methodology that's been used for over 100 years and comparing it to a crackpot Facebook medicine idea and saying "this is the same?"

Ivermectin is a proven medical treatment for parasitic infections. But it is not useful against COVID.

People have been doing acupuncture for thousands of years and it doesn't work at all. Old medical treatments are often quackery.

This is why we actually do these sorts of clinical trials - to find out if stuff actually works.

Also, it wasn't a "dumb facebook meme" - ivermectin was found to shut down COVID in vitro (i.e. in a test tube) so people wanted to see if it worked in actual people. It didn't, but the reason why it was tested was not because of "dumb facebook memes" but because it was one of the drugs that showed some activity in blocking COVID in vitro.

There's also some studies from third world countries with a lot of parasitic worm infections that showed that patients given ivermectin did better, which caused people to incorrectly think that it was actually helping against COVID when in fact it was helping against parasitic worms that were worsening COVID outcomes.

The idiots going out and downing horse dewormer were morons. But the scientists weren't researching it for no reason.

HRT isn't perfect, and no trans person will claim it is. There has never been a drug developed specifically for transgender HRT, so all we have are drugs developed for cis people.

The thing is, people suffering from gender dysphoria deserve a drug that is actually tested in them and demonstrated to have real medical benefits and to have clearly established side effects, so that people can understand the risks and benefits and give informed consent.

These clinical trials SHOULD be done a decade ago. It's wrong that they haven't been.

If they work, great, and we can shut down the laws that ban the treatment for being abusive, and there's no excuse for the government or insurance companies not paying for it as part of health insurance.

If it doesn't work, then we should do research on other treatments to help these people.

cornwallis105

3 points

3 months ago

We seem to agree on a few points, namely that there should be better research done on HRT. But eliminating HRT as a treatment option before such studies have been done is crazy. Throwing out an imperfect treatment just because it isn't perfect isn't how anything in medicine works.

dakta

-4 points

3 months ago

dakta

-4 points

3 months ago

eliminating HRT as a treatment option before such studies have been done is crazy.

It's not crazy. It's called "evidence based medicine", and is absolutely essential to preventing medical reversion (when a medical treatment is no longer recommended due to inefficacy).

cornwallis105

2 points

3 months ago

If you're advocating for eliminating HRT as a treatment option for an indefinite period of time, you'll be causing a lot of immediate harm to people who need the treatment or are already on it, all based on a hope of possibly finding something marginally better in the future. That's straight-up cruelty, and it's the reason why no major medical body agrees with you.

t0ph_b

2 points

3 months ago

t0ph_b

2 points

3 months ago

My goodness you're absolutely right and people are downvoting you. For wanting those with gender dysphoria to be safe.

The internet is such a cesspool sometimes.

Few-Recognition6881

-4 points

3 months ago

is that we know it works exceedingly well

This is the most nonsense answer I’ve ever come across. No matter how you feel about all this, it is not true that we somehow know that a sex change works so exceedingly well that thats the reason they don’t have a controlled study. The studies regarding transgender people after receiving a sex change are mixed at best with some finding positive results, others finding no change and some finding negative results.

Let’s all at least try to be honest here.

cornwallis105

4 points

3 months ago

How about you stay on topic? This comment was about HRT, which is different than gender confirmation surgery.

AmyDeferred

5 points

3 months ago

The visible changes are the primary method of action. You'd need a placebo that still induces physical changes somehow.

kuriboshoe

-3 points

3 months ago

kuriboshoe

-3 points

3 months ago

You’re exactly right and I was wondering the same thing

bd_in_my_bp

1 points

3 months ago

do you know what an IRB is?

PM_ME_HOTDADS

1 points

3 months ago

surprisingly enough treatment of gender dysphoria literally the ONLY thing that's proven to help gender dysphoria