Friday, April 19, 2024

The Cass Review and the WPATH SOC

The Cass Review draws some astonishing conclusions about the WPATH Standards of Care (SOC).

More or less, the basic upshot of the Cass Review's analysis is that the SOC is "based on shaky evidence".  They attempt to buttress this by applying the AGREE II framework to assess various SOC like frameworks (Taylor, Hall, Heathcote, Hewitt, Langton, & Fraser, 2024).  

Let’s Talk About Data Quality For a Moment

The recently released Cass Review Final Report (Cass Review) has criticized the absence of “high quality evidence” supporting the use of puberty blockers to treat transgender youth (as well as in other areas of transgender research).  

The systemic reviews performed as part of the Cass Review applied a “modified” version of something called the Newcastle-Ottawa Scale (NOS).  A brief review of several of the reviews (there are several of them) performed by the Cass team mention “modifying” the NOS, but they do not disclose the nature of the modifications made. Broadly speaking, they classify the vast majority of studies as “low quality”, while the final report spends quite a bit of time talking about “double blind” studies as the “gold standard” for high quality data. 

Let’s talk about that a bit further, shall we?  ( This will be one of several posts on the Cass Review Final Report)

Sunday, April 14, 2024

Trans Athletes ...

So, wayyyy back in 2021, I wrote a piece pointing out that a lot of the arguments about whether transgender athletes (and particularly trans women as athletes) have "intrinsic advantages" in sport are very questionable, and there simply isn't a lot of good science that backs up the claim.  A big part of the issue is that most of the studies seen to date were either comparisons between cisgender men and women, or if they involved transgender people at all, they did not necessarily involve transgender athletes.  

Yesterday, reported on a recent study that actually compared cisgender and transgender athletes in a cross-sectional study.  I would urge you to go read the study (actually, even the Outsports article is a pretty decent summary if you don't feel up to wading through the proper study).  

However, there are some interesting findings in the study that warrant further consideration when examining alleged advantage on a sport by sport basis:  

Transgender women presented lower absolute jump height than CM and lower relative jump height, normalised for fat-free mass, than transgender men and cisgender women (figure 4). These results in this study cohort suggest that transgender women lack lower body anaerobic power compared with the other groups. Transgender women’s higher absolute peak power than cisgender women (figure 4C), coupled with higher fat mass potentially driven by higher oestradiol concentrations (figure 1B), suggest that transgender women had more inertia to overcome during the explosive phase of the countermovement jump, which may lead to decreased performance. [Emphasis Added]

This one little quote is interesting because it aligns with my own personal experience with sports performance over the course of transition, and it contains much of the same basic reasoning that has led me to argue that any claim of "advantage" has to exist on a sport by sport basis, and must be underpinned by solidly done science that actually quantifies the claim instead of merely asserting it.  

Therefore, based on these limited findings, we recommend that transgender women athletes be evaluated as their own demographic group, in accordance with the principles outlined in Article 6.1b of the International Olympic Committee Framework on Fairness, Inclusion and Non-Discrimination based on Gender Identity and Sex Variations.4

In other words, the findings of this study demonstrate that most current studies that are often bandied about to claim that transgender women athletes have "massive advantages" don't show that at all, and a whole lot more evidence needs to be gathered before the various governing bodies go jumping off in all directions.  

Monday, April 08, 2024

Let’s Go Back To The DSM III !

Apparently there is a belief held among certain members of the trans community that we should go back in time … back to the days of the DSM III in particular - at least for what is now referred to as Gender Dysphoria.  (If you wish to read the DSM III section on Transsexualism, it’s Diagnostic Code 302.50 - in the chapter on Sexual Disorders, I think).

I have opinions.  

First, let me post the thread that I just read before I go off and explain just how incredibly wrong these people have it. 

There are a few things to bring out here.  First is a gross misunderstanding of the role / purpose of the DSM and its development.  Then we need to get into a discussion of just what treatment for transsexuals looked like back then, because wow - it wasn’t pretty.  

Saturday, March 30, 2024

You Got Played, Girl

 On March 19, 2024 the United Conservative Party of Alberta held an event that they called "Let Kids Be Kids" (spoiler alert:  it was an anti-trans/anti-2SLGBTQ/anti-SOGI/"parents rights" rally in reality).  

They brought in a transgender woman from Lethbridge to speak to the transgender case.  I don't know this person, but from their answers to the questions put to them, they clearly lack both research and clinical knowledge in the domain.  Being transgender does not mean that one has spent time in the academic and clinical literature relevant to this domain, and this is a problem.  

Her stated purpose was to engage in dialogue, but quite frankly, she got played.  In a 2 hour long event, she was allocated a grand total of 10 minutes during which the host asked them questions that she had to respond to.  The rest of the 2 hours was given over to opening comments, and presentations by some of the most dishonest players in the Alberta "parental rights" movement - and their presentations destroyed any semblance of "goodwill" and "open dialogue".  She got played for a patsy. 

Let me explain: 

Sunday, March 03, 2024

Collective Punishment

Ever since Pierre Poilievre opened his mouth and declared that Trans Women need to be banned from washrooms and locker rooms, there's been a steady increase in the amount of violent rhetoric aimed at the transgender community.  

In the midst of the above article, Senator Marilyn Gladu is quoted as follows: 

Gladu said trans women should not be allowed in women’s bathrooms or change rooms because “there have been incidents that have harmed women and young girls. And so we need to make sure that, you know, that’s not going to happen.”

To me, this reads like a variation on the "what about women who have been traumatized by violence from men?" argument.  It's largely a bad faith argument, because on so many different levels it misrepresents transgender women in particular and it ultimately infantilizes women by implying that they can't possibly be in the presence of a former male in such situations.

I frequently see unfounded claims that “transgender women exhibit male violence patterns” as part of the justification for this, and that is then used to argue that the entire class of transgender women should therefore be excluded.  This is deeply problematic reasoning.  

The second line of reasoning I see levelled at transgender women is the idea that allowing transgender women into designated female spaces will enable predators to come in and attack.  There is scant evidence that this is a thing, and considering that transgender women have been accessing female spaces for decades, it’s a bit hard to see how this is going to change now.  Besides, actual sexual predators aren’t exactly likely to masquerade as their prey - that would be a symbolic emasculation of themselves. 

A third line of reasoning is the idea that there are plenty of women who have been traumatized by abuse perpetrated at the hands of men.  Again, this comes around to a framing issue, and one that needs to be addressed relative to a population analysis. 

All of these are problematic from a number of perspectives, primarily in that they generally start from a perspective that because a transgender woman was designated male at birth, they are intrinsically a threat.

Thursday, February 29, 2024

On Drug Policy

Alberta in particular continues to ride the “War on Drugs” policy train from the 1980s.  In fact, in many ways the current UCP government has doubled down on it with an approach that basically says “recovery is the only option for addicts” - to the point of actually talking openly about using government coercive power to force people into treatment involuntarily.  

Their argument is largely based on a number of misguided notions about addiction, and how best to address it.  They largely view addiction as a personal moral failing - literally the addict is at fault for “putting the stuff in their body” in the first place, and should be grateful that we provide places for them to “get clean”.  

That is, to be charitable, a horribly naive way of looking at the issue.  I’m not going to spend a ton of time here reviewing the academic literature on addiction - if you want to get a taste of it, wander over to Google Scholar, and type in addiction and I think you’ll get a sense of the scope of the issues. 

However, since the 1980s, the illicit drugs world has changed a lot. Back then the most dangerous substances were things like heroin, or possibly freebasing cocaine.  Overdoses certainly happened, but compared to now they were rare. Today’s drug supply on the street is many orders of magnitude more dangerous, and compounds are being mixed together in ways that most of us can’t even begin to imagine. 

I do agree that addiction is a major problem for policy makers to address.  Where I disagree with policy makers across the board is in the simplistic, one (or maybe two) dimensional approaches to government policy being implemented.  We cannot treat this as a singular monolith issue any longer. 

We need to implement a package of policies to deal with the issues - and it will take significant resources on multiple fronts to do it right. 

A Proposal

The Cass Review and the WPATH SOC

The Cass Review draws some astonishing conclusions about the WPATH Standards of Care (SOC) . More or less, the basic upshot of the Cass Rev...