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Feature Trans Care

Gender dysphoria in children: puberty blockers study draws further criticism

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l5647 (Published 20 September 2019) Cite this as: BMJ 2019;366:l5647

Rapid Response:

Re: Gender dysphoria in children: puberty blockers study draws further criticism

As journalists, reading some of the rapid responses to this article is depressing, highlighting a misunderstanding of “investigative journalism”.

Letters by Shaw and Scott et al fail to recognise why journalists have been drawn into reporting on interventions and research in transgender health and misrepresent what we have written. We will attempt to correct their false statements about the article; about us as reporters; and how the piece came about.

We did not set out to “investigate” the use of puberty blockers or an unpublished scientific study. We have a duty to examine claims that are brought to us that are of significant public interest – particularly when accompanied by primary documentation. Some people working in the field of gender identity are fearful of speaking about concerns they have about the evidence base. This is the very reason why journalism has a crucial role in scientific discourse, and we have no agenda other than to explore current debate.

We reject the assertion that we employed alarmist language. We looked at the evidence and primary source documents. We sought expert opinion from a wide variety of sources – from those who write clinical guidelines for NICE to statisticians involved in drug trials. Crucially, we also spoke with clinicians working in gender identity services and transgender people.

We interviewed Hannah Philips, a young transgender woman, on the record. Our quotes from this were an accurate reflection of what she told us, and what she has said publicly on her YouTube channel.

It seems an odd criticism that we referred to gonadotropin releasing hormone analogues as puberty blockers. This is how gender clinics around the world and academic researchers often refer to them.

Nor do we suggest that treatment with GnRHas may be responsible for persistence. We said that the limited existing studies show the majority - if not all - young people taking GnRHas at the onset of puberty – so-called ‘early intervention’ – progressed to cross-sex hormones. However, GnRHas are presented to young people and their families as providing time and space to think.

In their investigation into the early intervention study, the Health Research Authority warned against describing puberty blockers as “providing a ‘breathing space’”. Instead it described the treatment in the following way: “the suppression of puberty would allow subsequent cross sex hormone treatment without the need to surgically reverse or otherwise mask the unwanted physical effects of puberty in the birth gender”.

We reject any charge that we suggested that young trans-identifying people could ‘contaminate’ others. Moreover, comparing this feature to homophobic reporting some three decades ago is highly offensive, and we can see nothing in our reporting that could possibly warrant such an allegation. Indeed, we argued the opposite - that the transgender community should be entitled to the same standard of health research and care as anyone else.

In response to Scott et al, others are better placed to debate the merits of study design. We merely reported the fact the first research ethics committee had rejected the early intervention study because it didn’t have a control group. We made no judgement. Nor did we comment on clinical decision making or that researchers didn’t warn about harms. We reported that a Dutch study had showed all who take GnRHas at early stage puberty went on to take cross sex hormones and that this was not in the consent forms or in the study protocol.

We did not make any judgement that triptorelin is used “off label” in gender dysphoria. Nor did we prejudge the study’s results. We reported the researcher’s own analysis showing an increase in suicidal ideation whilst making public statements about how their results were positive. We were told this was based on a questionnaire – one that we haven’t seen nor has been published.

Contrary to what Scott et al say, we actually point out that we do not know if the observed suicidal ideation in some participants is a treatment effect because the study design does not allow that causal link to be made.

We strongly reject any accusation bias.

Competing interests: Deborah Cohen is former Investigations Editor of The BMJ. Hannah Barnes, no competing interests.

15 November 2019
Deborah Cohen
correspondent
Hannah Barnes, senior journalist,
BBC Newsnight