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.  

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...