Over the summer, reports emerged of a re-analysis of Tavistock data relating to the mental health of forty-four children before and after commencing puberty blockers (PBs). The data was originally analysed in a manner that was not very statistically sophisticated, with the result that conclusions from the analysis were too broad-brush to be useful.
The re-analysis looked at child-by-child outcomes in terms of whether each child had shown ‘reliable improvement’ (meaning, improvement beyond the range that could be expected simply as an artefact of a questionnaire’s inherent inexactitude, or ‘measurement error, as statisticians call it), no change, or reliable deterioration. This showed that 71 per cent either "reliably deteriorated" in terms of their mental health (34%) or showed no change (37%), while just 29 per cent "reliably improved" twelve months after taking puberty blockers.
The rationale for prescribing puberty blockers is that they put a temporary stop to the trauma of impending adolescent development. One would think, therefore, that gender dysphoric children would feel less depressed or anxious once they were taking PBs. They are frequently touted as being harmless and irreversible, but recent research points to side effects such as reduced bone density and possible cognitive problems. For example, there is good evidence of disrupted cognition in animal studies, and some evidence of reduced cognitive ability in studies of children experiencing precocious puberty, who were taking PBs.. Given the potential for harm arising out of puberty blockers, it is surely important to know whether the anticipated benefits in terms of improved mental health are being achieved. Clearly, at the Tavistock they were not.
We recently wrote to the Sandyford Clinic to ask about their own data in relation to mental health outcomes in the children that were taking puberty blockers. We asked three questions:
1.Can you please indicate whether or not the Sandyford Clinic collects mental health data on children and young people who have been prescribed PBs.
2.If it does, can you say whether that data has been carefully analyzed (bearing in mind that the original Tavistock analysis was statistically flawed, and thus failed to identify that their data was bimodally distributed).
3.Finally, if the Sandyford data has been analysed, can you let me know the outcomes in terms of reliable improvement, reliable deterioration and no reliable change.
ScotPAG response to FOI letter
The Sandyford replied to say that mental health measures are administered every three months, as part of the child’s regular psychological assessment, to those children who are taking PBs. However, those measures have not been analyzed and therefore the Sandyford is unable to say whether their cohort of children have benefited in terms of their mental health from the introduction of PBs.
We have some sympathy with the clinical staff at the Sandyford. They are busy clinicians who no doubt don’t have sufficient time to undertake statistical analysis of the data that they hold. Even so, it is alarming that the Sandyford Clinic currently has no idea whether those of its patients who are taking PBs are benefiting from them. The evidence from the Tavistock would suggest that they probably aren’t.
It is encouraging to see that the Scottish Government is considering funding research into aspects of what has been characterised as "transgender healthcare". But what research? And within what parameters? We already have evidence of the SG using very poor research evidence as justification for ideological approaches; witness the use of extremely poor research referred to in the Scottish Government guidance 'Supporting Trans Pupils in Schools'.
We suggest that analysis of data that the Sandyford has already collected would be a good starting point. But a Scottish Government research programme needs to go much further. The Cass review has recommended that the whole field of paediatric gender care be conducted within a research paradigm. Cass suggests this because of the very poor exisiting evidence base for medical transition. We can only agree. There is an urgent need for high quality, longitudinal research in this area, particularly the psychological aspects. Until the results of that are available, medical professionals have a duty to proceed with extreme care, remembering to “first, do no harm”.
Dr John Higgon